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Koch M, Seifart C. Rethinking parameters of "success" in breaking bad news conversations from patient's perspective: the successful delivery process model. Support Care Cancer 2024; 32:181. [PMID: 38386098 PMCID: PMC10884081 DOI: 10.1007/s00520-024-08354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Studies that focus on improving the difficult process of breaking bad news in oncology should include the patient perspective and be guided by appropriate outcome measures. Endpoints such as "patient satisfaction" fall short to capture the complex nature of breaking bad news (BBN) conversations. However, this is true of many studies. The present study attempts to develop a framework model from a new, patient-centered perspective, which can be applied equally in clinical practice and in education. METHODS Semi-structured in-depth interviews with twelve cancer patients were conducted. Transcripts were analyzed by "qualitative content analysis" following Mayring. Outcomes were further extrapolated in interpretational steps, and a model of "success" from patients view in BBN was developed. RESULTS Two central needs of the patients could be identified: understanding and feelings. Their fulfillment depends on two groups of variables: first, structural characteristics, such as the inevitable shock, individuality, and processability; second, strongly influenceable variables, such as relationship, transfer of knowledge, and atmosphere. From these results, a framework model for successful breaking of bad news from the patient's perspective was developed: The successful delivery process model (SDP model). CONCLUSION As a basic model for the framework for breaking bad news from the patient's perspective, the SDP model can be applied to many different situations in oncology and help to frame the difficult conversations by tailoring the BBN conversations on determinants that favorably influence the process in a patient centered manner. In this sense, the model can be useful in clinical practice as well as in education.
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Affiliation(s)
- Martin Koch
- Clinic for Internal Medicine I, University Hospital, Technical University, Dresden, Germany
| | - Carola Seifart
- Research Group Ethics in Medicine, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany.
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2
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Hughes K, Blackett L, Jacobson CEH, Henley SMD, Carr E. A Systematic Review of the Psychosocial Measures Used in Teenage and Young Adult Cancer. J Adolesc Young Adult Oncol 2024; 13:30-39. [PMID: 37477895 DOI: 10.1089/jayao.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background: Teenagers and young adults (TYAs; ages 16-24 in the United Kingdom) with cancer have specific needs and experience worse physiological and psychological outcomes compared with pediatric and adult cancer. In the United Kingdom, psychosocial screening is a mandatory part of TYA care. However, there is a lack of age-appropriate and acceptable psychosocial measures for this population. This review aimed to (1) identify the psychosocial measures utilized and available for TYA cancer and (2) describe their psychometric properties. Methods: We searched five databases for studies meeting the eligibility criteria. We extracted data relevant to the review and assessed study quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and the Hughes Quality Assessment Tool developed by the research team. Results: We identified 40 studies that included 105 psychosocial measures. The main constructs measured were distress, depression, and anxiety. The TYA age range varied widely. Reporting of psychosocial measures and their psychometric properties was poor, and most measures were not validated or developed for TYA cancer populations. Discussion: There is an urgent need for psychosocial measures that are designed for and validated in TYA cancer populations. Appropriate measures would enable clinicians to reliably identify and effectively support the psychosocial challenges faced by TYAs. The use of validated psychosocial measures enables earlier detection of difficulties, fosters patient-centered care, and is cost-effective since resources can be allocated to those most in need.
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Affiliation(s)
- Kathryn Hughes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Laura Blackett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Susie M D Henley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, King's College London, London, United Kingdom
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Neylon K, Condren C, Guerin S, Looney K. What Are the Psychosocial Needs of Adolescents and Young Adults with Cancer? A Systematic Review of the Literature. J Adolesc Young Adult Oncol 2023; 12:799-820. [PMID: 37130327 DOI: 10.1089/jayao.2022.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Adolescents and young adults with cancer (AYACs) have become recognized as a unique group in recent years. The unique developmental context and related challenges of being a young person with a cancer diagnosis can lead to a distinct and diverse set of psychosocial issues. Existing research has attempted to explore these psychosocial needs and challenges and to develop appropriate and individualized interventions. However, the needs of this group remain unmet, with ongoing calls for individualized support. This systematic review addressed the research question, "what are the psychosocial needs of AYACs aged 15-24 years?." PubMed, PsycINFO, and CINAHL databases were searched to identify relevant studies from January 2000 to December 2022 (inclusive). Qualitative, quantitative, and mixed methods designs were included and 29 studies met inclusion criteria. Findings provide an overview of needs from the existing literature and support the idea of a changing constellation of psychosocial needs for AYACs in areas such as identity, relationships, mental health, autonomy, and occupation. The main implications for theory and future research include the importance of the developmental context and consideration of discrepancies in the age range used within the literature to define this group.
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Affiliation(s)
- Karen Neylon
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - Caoimhe Condren
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - Kathy Looney
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
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Michaud AL, Bice B, Miklos E, McCormick K, Medeiros-Nancarrow C, Zhou ES, Recklitis CJ. Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA): Protocol for an Efficacy Trial. JMIR Res Protoc 2023; 12:e52315. [PMID: 38019571 PMCID: PMC10719817 DOI: 10.2196/52315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Young adult cancer survivors (YACS) are at elevated risk for chronic insomnia, even years after completing treatment. In addition to potential health consequences, insomnia can interrupt social, educational, and vocational development just as they are trying to "make up" for time lost to cancer. Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment for insomnia but remains largely unavailable to YACS due to several barriers (ie, shortage of trained providers, geographic limitations, financial limitations). Traditional CBTI has not been adapted to meet YACS' unique developmental and circadian challenges. To improve availability of effective behavioral insomnia treatment for this population, we developed the Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA), a low-intensity educational intervention delivered virtually online. OBJECTIVE In this phase 2 "proof of concept" trial, primary aims are to test the efficacy of STEP-YA to improve insomnia symptoms and mood in YACS and assess the utility of individualized coaching to improve treatment effects. A secondary aim will explore participant variables associated with clinically significant response to STEP-YA. METHODS This 2-arm randomized prospective trial will enroll 74 off-treatment YACS aged 20 years to 39 years with clinically significant insomnia. Each participant completes the STEP-YA intervention in a 1-on-1 synchronous online session led by a trained interventionist following a structured outline. The 90-minute intervention presents educational information on the development of insomnia after cancer and offers specific suggestions for improving insomnia symptoms. During the session, participants review the suggestions and develop a personalized sleep action plan for implementing them. After the session, participants are randomized to either the coaching condition, in which they receive 2 telephone coaching sessions, or the no-coaching condition, which offers no subsequent coaching. The Insomnia Severity Index (ISI) and the Profile of Mood States: Short Form (POMS-SF) are assessed at baseline and 4 and 8 weeks postintervention. RESULTS Enrollment began in November 2022, with 28 participants currently enrolled. We anticipate recruitment will be completed in 2024. The primary endpoint is a change in ISI score from baseline to 8 weeks postintervention. The secondary endpoint is change in mood symptoms (POMS-SF) from baseline to 8 weeks postintervention. Change scores will be treated as continuous variables. Primary analyses will use ANOVA methods. A within-subjects analysis will examine if the STEP-YA intervention is associated with significant changes in insomnia and mood over time. A 2-way ANOVA will be used to evaluate the utility of coaching sessions to improve treatment effects. CONCLUSIONS Chronic insomnia has significant negative effects on YACS' medical, educational, and psychological functioning. STEP-YA aims to address their needs; study results will determine if the intervention warrants future effectiveness and dissemination studies and if individualized coaching is necessary for adequate treatment response. TRIAL REGISTRATION ClinicalTrials.gov NCT05358951: https://clinicaltrials.gov/study/NCT05358951. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52315.
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Affiliation(s)
- Alexis L Michaud
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Briana Bice
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Eva Miklos
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Katherine McCormick
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | | | - Eric S Zhou
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Hovén E, Ljungman L, Sveen J, Skoglund C, Ljungman G, Ljung R, Wikman A. Losing a child to adolescent cancer: A register-based cohort study of psychotropic medication use in bereaved parents. Cancer Med 2023; 12:6148-6160. [PMID: 36218005 PMCID: PMC10028064 DOI: 10.1002/cam4.5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the short- and long-term risk of psychotropic medication use in parents who lose a child to cancer diagnosed in adolescence. METHODS This is a Swedish nationwide register-based study including 184 bereaved mothers and 184 bereaved fathers of 184 children diagnosed with cancer in adolescence. Logistic regression analyses, adjusted for sociodemographic characteristics and history of mental health problems, were performed to estimate risk of a prescription of psychotropic medication (anxiolytics, hypnotics/sedatives, antidepressants) in cancer-bereaved parents from 1 year before to 5 years after the child's death, with a general population sample of non-bereaved parents (n = 3291) as referents. RESULTS At the year of the child's death, 28%-36% of mothers and 11%-20% of fathers had a prescription of anxiolytics, hypnotics/sedatives or antidepressants. The corresponding percentages for non-bereaved mothers and fathers were 7%-12% and 4%-7%, respectively. Compared to non-bereaved mothers, bereaved mothers showed higher odds of prescriptions from 1 year before up to four (anxiolytics) and 5 years (hypnotics/sedatives and antidepressants) after the child's death. Bereaved fathers showed higher odds than non-bereaved fathers of prescriptions from 1 year before up to the year of (anxiolytics and hypnotics/sedatives) and 1 year after (antidepressants) the child's death. No differences in odds between bereaved and non-bereaved fathers were found at 2 years after the child's death. Being unmarried, born outside Sweden, and having a history of mental health problems were associated with higher odds of prescribed medications. CONCLUSIONS Indicative of mental health problems of clinical importance, cancer-bereaved parents had a higher prevalence of use of psychotropic medication. A decrease in medication use was evident with time, but still at 5 years after the child's death mothers displayed a higher use while fathers showed no difference to non-bereaved fathers after 2 years.
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Affiliation(s)
- Emma Hovén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Childhood Cancer Research Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Lisa Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Josefin Sveen
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Crisis PsychologyUniversity of BergenBergenNorway
| | | | - Gustaf Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Pediatric OncologyUppsala University HospitalUppsalaSweden
| | - Rickard Ljung
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Anna Wikman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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Prevalence and associated factors of psychological distress among young adult cancer patients in Japan. Palliat Support Care 2023; 21:93-99. [PMID: 35225198 DOI: 10.1017/s1478951521002054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Adolescent and young adult (AYA) cancer patients may be at high risk of experiencing psychological distress because their diagnosis came during a key time of consolidation of identity and social growth. This study aimed (1) to examine the prevalence of psychological distress among AYA cancer patients within a year of diagnosis to long-term survivors and (2) to describe socio-demographic and cancer-related characteristics associated with psychological distress. METHODS In a cross-sectional web-based survey, patients who scored 5 or more on the Kessler Psychological Distress Scale were assessed for significant psychological distress. Logistic regression examined whether demographics, clinical variables, and social support were associated with psychological distress. RESULTS A total of 206 young adult cancer patients participated. The median age at the survey was 34.5 years (range: 22-39 years), and 87.4% were female. The prevalence of psychological distress was 55.3%. Psychological distress among patients diagnosed within a year and long-term survivors (≥10 years since diagnosis) was significantly higher than patients 1-4 years since diagnosis. Pain, decrease in income after a cancer diagnosis, experience of negative change in work/school after a cancer diagnosis and poor social support were significantly associated with psychological distress. SIGNIFICANCE OF RESULTS Over half of young adult patients had significant psychological distress in Japan. Our findings potentially contribute to the intervention components for distress management among AYA cancer survivors.
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7
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Umaretiya PJ, Fisher L, Altschuler A, Kushi LH, Chao CR, Vega B, Rodrigues G, Josephs I, Brock KE, Buchanan S, Casperson M, Fasciano KM, Kolevska T, Lakin JR, Lefebvre A, Schwartz CM, Shalman DM, Wall CB, Wiener L, Bona K, Mack JW. "The simple life experiences that every other human gets": Desire for normalcy among adolescents and young adults with advanced cancer. Pediatr Blood Cancer 2023; 70:e30035. [PMID: 36308744 DOI: 10.1002/pbc.30035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with advanced cancer identify normalcy as an important component of quality end-of-life care. We sought to define domains of normalcy and identify ways in which clinicians facilitate or hinder normalcy during advanced cancer care. PROCEDURE This was a secondary analysis of a qualitative study that aimed to identify priority domains for end-of-life care. Content analysis of semi-structured interviews among AYAs aged 12-39 years with advanced cancer, caregivers, and clinicians was used to evaluate transcripts. Coded excerpts were reviewed to identify themes related to normalcy. RESULTS Participants included 23 AYAs with advanced cancer, 28 caregivers, and 29 clinicians. Participants identified five domains of normalcy including relationships, activities, career/school, milestones, and appearance. AYAs and caregivers identified that clinicians facilitate normalcy through exploration of these domains with AYAs, allowing flexibility in care plans, identification of short-term and long-term goals across normalcy domains, and recognizing losses of normalcy that occur during cancer care. CONCLUSIONS AYAs with cancer experience multiple threats to normalcy during advanced cancer care. Clinicians can attend to normalcy and improve AYA quality of life by acknowledging these losses through ongoing discussions on how best to support domains of normalcy and by reinforcing AYA identities beyond a cancer diagnosis.
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Affiliation(s)
- Puja J Umaretiya
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren Fisher
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brenda Vega
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Gilda Rodrigues
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Katharine E Brock
- Divisions of Pediatric Oncology and Palliative Care, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Karen M Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tatjana Kolevska
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anna Lefebvre
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Corey M Schwartz
- Division of Medical Oncology, Kaiser Permanente Northern California, Oakland, California, USA
| | - Dov M Shalman
- Department of Palliative Care, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Catherine B Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lori Wiener
- Psychosocial Support and Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
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Wikman A, Hovén E, Alvariza A, Lövgren M, Kreicbergs U, Skoglund C, Fransson E, Ljungman G, Ljung R, Ljungman L. Psychotropic medication use in parents of survivors of adolescent cancer: A register-based cohort study. Cancer Med 2022; 11:4341-4353. [PMID: 35474312 DOI: 10.1002/cam4.4780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim was to investigate psychotropic medication use in parents of survivors of adolescent cancer from the acute post-diagnostic phase and up to 2 years following the cancer diagnosis. METHODS This study had a nationwide register-based cohort design comparing psychotropic medication use in parents of adolescent survivors of cancer (n = 2323) to use in parents of cancer-free controls (n = 20,868). Cox proportional hazards models, adjusted for cancer diagnostic group, parents' age, country of birth, education level, marital status and previous mental health problems estimated the risk of use from the time of the cancer diagnosis up to 2 years later. RESULTS During the first 6 months after the cancer diagnosis, both mothers and fathers had an increased risk of use of anxiolytics (mothers: HRadj 1.71, 95% CI 1.30-2.25; fathers: HRadj 1.57, 95% CI 1.10-2.45) and hypnotics/sedatives (mothers: HRadj 1.53, 95% CI 1.23-1.90; fathers: HRadj 1.32, 95% CI 1.00-1.75). For fathers with a prescription of psychotropic medication during the first 6 months after the cancer diagnosis, the risk remained increased after 6 months (HRadj 1.66, 95% CI 1.04-2.65). From 6 months after the cancer diagnosis, only the risk of antidepressant use among mothers was increased (HRadj 1.38, 95% CI 1.08-1.76). Risk factors included being divorced/widowed, born in a non-Nordic country, older age and having had previous mental health problems. CONCLUSION Our study results show that during the immediate post-diagnostic phase, mothers and fathers of survivors of adolescent cancer are at increased risk of use of anxiolytics and sedatives, whereas only mothers are at increased risk of antidepressant use from 6 months until 2 years after the diagnosis. Further, previous mental health problems were shown to be the strongest risk factor for psychotropic medication use in both mothers and fathers, pointing to the particular vulnerability of these parents.
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Affiliation(s)
- Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Hovén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Malin Lövgren
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Advanced Pediatric Home Care, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | | | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Koehler M, Hoppe S, Kropf S, Lux A, Bartsch R, Holzner B, Krauter J, Florschütz A, Jentsch-Ullrich K, Frommer J, Flechtner HH, Fischer T. Randomized Trial of a Supportive Psychotherapy for Parents of Adolescents and Young Adults With Hematologic Malignancies. J Natl Compr Canc Netw 2022; 20:jnccn20614. [PMID: 35405661 DOI: 10.6004/jnccn.2021.7075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer regularly disrupts health and developmental trajectories in adolescents and young adults (AYAs). Parents have been shown to have a substantial impact on the health and cancer survivorship activities of AYA patients in the form of symptom management. However, no randomized controlled trial has evaluated a coping support intervention (CSI) program for parents of AYAs with cancer aged 18 to 40 years. PATIENTS AND METHODS From November 30, 2012, to August 29, 2016, parents of AYAs with hematologic malignancies were randomized in a phase III controlled trial (1:1 ratio, stratified sampling) to either the research-based CSI AYA-Parents group (CSI group; n=82) or the standard care (SC) group (n=70). CSI consisted of 5 sessions to achieve the enhancement of parental adaptive coping as the primary outcome (per the adaptive coping scale of the 28-item Brief COPE, a validated multidimensional self-assessment-questionnaire recommended for clinical cancer research). Measures of adaptive coping, depression, and mental health were collected at pre-CSI (measurement date T1), at the end of the intervention sessions (measurement date T2), and at follow-up (3 months). We calculated mean change scores in outcomes and estimated intervention effect sizes (Cohen's d) for changes from T1 to T2/T3, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. All statistical tests were 2-sided. RESULTS In the intention-to-treat analysis, the CSI group significantly improved their adaptive coping compared with the SC group (95% CI, 0.30-2.54; P=.013; d=0.405), whereas adaptive coping in the SC group deteriorated. The CSI group also experienced a significant decrease in depressive symptoms and improved mental health with clinical significance (95% CI, -1.98 to -0.30; P=.008; d=0.433, and 95% CI, -0.19 to 3.97; P=.074; d=0.292, respectively). Sensitivity analyses confirmed the robustness of the main intention-to-treat analysis. CONCLUSIONS CSI improved effectively adaptive coping and depression in parents of AYAs with hematologic malignancies. It may represent a novel family-based approach in AYA oncology care.
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Affiliation(s)
- Michael Koehler
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Susanne Hoppe
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Siegfried Kropf
- 3Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Anke Lux
- 3Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Rainer Bartsch
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Bernhard Holzner
- 4Department of Psychiatry, Psychotherapy and Psychosomatic, Innsbruck Medical University, Innsbruck, Austria
| | - Juergen Krauter
- 5Department of Hematology and Oncology, Braunschweig Municipal Hospital, Braunschweig, Germany
| | - Axel Florschütz
- 6Department of Internal Medicine, Dessau Municipal Hospital, Dessau-Roßlau, Germany
| | | | - Joerg Frommer
- 8Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, and
| | - Hans-Henning Flechtner
- 9Department of Child and Adolescent Psychiatry, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Fischer
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
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10
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Hodgson J, Lamson A, Kolobova I, Tucker E, Brimhall A, Lea CS, Brinkley J. The Experience of Distress and Coping Among Young Adults with Cancer and Their Caregivers. CONTEMPORARY FAMILY THERAPY 2021. [DOI: 10.1007/s10591-021-09592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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De Salvo A, De Ioris MA, Secco D, Bevilacqua F, Premuselli R, Amicucci M, Ciaralli I, Santato F, Mastronuzzi A, Milano GM. The 4YouLab Model: A Dedicated-Program for Adolescents and Young Adults With Cancer in a Children's Hospital. Front Oncol 2021; 11:705419. [PMID: 34277449 PMCID: PMC8280455 DOI: 10.3389/fonc.2021.705419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea De Salvo
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Domitilla Secco
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Francesca Bevilacqua
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Roberto Premuselli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Matteo Amicucci
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Italo Ciaralli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Francesca Santato
- Unit of Clinical Psychology, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
| | - Giuseppe Maria Milano
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCSS), Rome, Italy
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12
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Hanghøj S, Pappot N, Hjerming M, Taarnhøj GA, Boisen KA, Pappot H. Experiences of Social Isolation During the COVID-19 Lockdown Among Adolescents and Young Adult Cancer Patients and Survivors. J Adolesc Young Adult Oncol 2021; 10:142-147. [PMID: 33601980 DOI: 10.1089/jayao.2020.0202] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: COVID-19 is a worldwide pandemic affecting populations by massive lockdowns, including strict precautions and quarantines. Research on the lives of adolescents and young adults (AYAs) with cancer during the COVID-19 pandemic is highly relevant to meet potential challenges regarding their physical and mental well-being. Therefore, the purpose of this study was to investigate how AYA cancer patients and survivors experience social isolation during the COVID-19 lockdown. Methods: Individual semistructured telephone interviews were performed with 13 AYA cancer patients and survivors aged 18-29 years. All participants were users of Kræftværket, a youth support center and social organization for AYAs with cancer at The University Hospital Rigshospitalet, Denmark. Data were analyzed by using thematic analysis. Results: The following themes were found. The need for giving and receiving support, Difficulty of the community spirit, The lockdown's effect on recovery, Disrupted youth, and Being alone. Conclusion: The participants in this study experienced loneliness, anxiety, lack of psychosocial support, and lack of physical contact. In addition, lack of rehabilitation and lack of support during hospital visits, which may specifically influence the disease trajectory, were reported. Thus, health care professionals have an important task to follow up on the AYA's well-being during and after the COVID-19 lockdown. A positive side effect of the lockdown period was the experience of getting a respite to recover physically and mentally after cancer.
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Affiliation(s)
- Signe Hanghøj
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Pappot
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Hematology and Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gry Assam Taarnhøj
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten A Boisen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Institute for Clinical Medicine, Copenhagen, Denmark
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13
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Wayant C, Manquen J, Wendelbo H, Kerr N, Crow M, Goodell J, Tricco AC, Mack JW, Hellman C, Vassar M. Identification of Evidence for Key Positive Psychological Constructs in Pediatric and Adolescent/Young Adult Patients with Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2021; 10:247-259. [PMID: 33464990 PMCID: PMC8220547 DOI: 10.1089/jayao.2020.0184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Children and adolescents/young adults (AYAs) with cancer are a vulnerable population susceptible to numerous late effects, such as fatigue and depression, which may diminish their long-term psychological, physical, spiritual, and emotional health. A well-rounded understanding of how positive psychological constructs affect the quality of care and treatment outcomes is therefore warranted. Methods: We conducted a scoping review of 15 positive psychological constructs in children and AYAs with cancer. The primary research questions were (1) what is known about positive psychological constructs in children and AYAs with cancer; (2) what value is ascribed to these constructs by patients? Results: Two hundred seventy-six articles were included after database search and screening. These studies were mostly observational or qualitative and conducted in North America. Constructs were often poorly defined, and measurement tools used to gather data were wide ranging. Numerous factors were correlated with increased or decreased expression of certain constructs, but overall themes were difficult to identify. Similarly, patients often spoke of what increased or decreased expression of a construct, with less emphasis on what they implicitly value. Discussion: This scoping review found ample evidence for what increases or decreases expression of positive psychological constructs, but this evidence was observational and often conflicting. In the future, we recommend the development of a core set of psychological outcomes, with definitions and corresponding measurement tools. We further recommend an emphasis on randomized trials to more rigorously study how expression of constructs can be improved and what effect this has on the quality of life.
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Affiliation(s)
- Cole Wayant
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jack Manquen
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Hannah Wendelbo
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Natalie Kerr
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Crow
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jon Goodell
- Department of Library Services, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chan Hellman
- School of Social Work, University of Oklahoma, Norman, Oklahoma, USA
| | - Matt Vassar
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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14
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Okamura M, Fujimori M, Sato A, Uchitomi Y. Unmet supportive care needs and associated factors among young adult cancer patients in Japan. BMC Cancer 2021; 21:17. [PMID: 33402126 PMCID: PMC7786954 DOI: 10.1186/s12885-020-07721-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Young adult cancer patients often face unique challenges and have potential unmet needs. This study aimed (1) to describe unmet supportive care needs among young adults with cancer in Japan, and (2) to identify its associated factors. Methods In a cross-sectional web-based survey, 206 young adults with cancer were assessed for supportive care needs. Multiple regression analysis examined whether demographics, clinical variables and social support were associated with unmet supportive care needs. Results A total of 206 patients (180 female) with a mean age of 33.7 years (SD = 4.3, range: 22–39) participated. One hundred and fifty-eight participants (76.7%) reported at least one unmet supportive care needs. The top 20 unmet needs included 9 of the 10 psychological needs, 3 of the 5 physical and daily living needs, 8 of the 11 health system and information needs and 1 of the 5 sexuality needs. Multiple regression analysis revealed that perceived poorer PS, experience of change in work/school after a cancer diagnosis and poor social support were significantly associated with higher supportive care needs. The total score of supportive care needs was significantly associated with both psychological distress and QOL. Conclusions More than 70% of young adult cancer patients reported unmet supportive care needs and most of those were psychological needs. The findings suggest potential opportunities for intervention in addressing psychological needs rather than physical and information needs.
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Affiliation(s)
- Masako Okamura
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan. .,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan.
| | - Ayako Sato
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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15
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Hovén E, Ljung R, Ljungman G, Ljungman L, Skoglund C, Fransson E, Wikman A. Increased risk of mental health problems after cancer during adolescence: A register-based cohort study. Int J Cancer 2020; 147:3349-3360. [PMID: 32535927 DOI: 10.1002/ijc.33154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 01/21/2023]
Abstract
In this nationwide, register-based study, we estimated the risk of mental health problems in 2822 individuals diagnosed with cancer in adolescence (13-19 years). Mental health problems were assessed by psychiatric diagnoses and/or prescribed psychotropic drugs. Cox proportional hazards models estimated hazard ratio (HR) for a psychiatric diagnosis and prescription of psychotropic drug compared to a matched comparison group (n = 28 220). Estimates were adjusted for calendar period and parent characteristics (eg, history of psychiatric diagnosis, education, country of birth). We found an increased risk of a psychiatric diagnosis during the first 5 years after the cancer diagnosis (females: HR 1.23, 95% CI, 1.06-1.44; males: HR 1.32, 95% CI, 1.11-1.56), and at >5 years after diagnosis (females: HR 1.31, 95% CI, 1.09-1.58, males: HR 1.45, 95% CI, 1.18-1.77). The risk of being prescribed antidepressant (females: HR 1.54, 95% CI, 1.30-1.84, males: HR 2.06, 95% CI, 1.66-2.55), antipsychotic (females: HR 2.28, 95% CI, 1.56-3.34, males: HR 3.07, 95% CI, 2.13-4.42), anxiolytic (females: HR 1.95, 95% CI, 1.64-2.31, males: HR 4.02, 95% CI, 3.34-4.84) and sedative drugs (females: HR 2.24, 95% CI, 1.84-2.72, males: HR 3.91, 95% CI, 3.23-4.73) were higher than for comparisons during the first 5 years after diagnosis. Median age at first psychiatric diagnosis and first prescribed psychotropic drug were 18 years. In conclusion, cancer during adolescence is associated with increased risk of mental health problems that may develop in close proximity to treatment. The findings emphasize the need for comprehensive care during treatment and follow-up.
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Affiliation(s)
- Emma Hovén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lisa Ljungman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Skoglund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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16
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De Salvo A, Amicucci M, Ciaralli I, Secco D, Miele E, Bevilacqua F, Milano GM. How to be together and carry on our project activities during COVID-19 pandemic in Rome. Pediatr Blood Cancer 2020; 67:e28431. [PMID: 32748503 PMCID: PMC7435538 DOI: 10.1002/pbc.28431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Andrea De Salvo
- Department of Pediatric Hematology/Oncology and Cell and Gene TherapyBambino Gesù Children's HospitalRomeItaly
| | - Matteo Amicucci
- Department of Pediatric Hematology/Oncology and Cell and Gene TherapyBambino Gesù Children's HospitalRomeItaly
| | - Italo Ciaralli
- Department of Pediatric Hematology/Oncology and Cell and Gene TherapyBambino Gesù Children's HospitalRomeItaly
| | - Domitilla Secco
- Department of Pediatric Hematology/Oncology and Cell and Gene TherapyBambino Gesù Children's HospitalRomeItaly
| | - Evelina Miele
- Department of Pediatric Hematology/Oncology and Cell and Gene TherapyBambino Gesù Children's HospitalRomeItaly
| | - Francesca Bevilacqua
- Unit of Clinical Psychology, Department of Neuroscience and NeurorehabilitationBambino Gesù Children's HospitalRomeItaly
| | - Giuseppe Maria Milano
- Department of Pediatric Hematology/Oncology and Cell and Gene TherapyBambino Gesù Children's HospitalRomeItaly
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17
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Fitch MI, Nicoll I, Lockwood G, Chan RJ, Grundy P. Adolescent and Young Adult Perspectives on Challenges and Improvements to Cancer Survivorship Care: How Are We Doing? J Adolesc Young Adult Oncol 2020; 10:432-442. [PMID: 32931343 DOI: 10.1089/jayao.2020.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose was to review main challenges experienced by adolescent and young adult (AYA) cancer survivors (18-34 years) during transition to survivorship and their suggestions regarding improvements needed in care. Methods: A national survey was conducted to identify experiences with follow-up care 1-3 years after cancer treatment. The survey included open-ended questions for respondents to add topics of importance and details for deeper insight. This study presents analysis of open-ended questions about main challenge faced by AYA respondents and their suggestions for improvements in care. Results: Of 575 AYA survey respondents, 497 (86.4%) commented regarding main challenges. Twenty-one indicated that they had no challenges. Of those reporting challenges, 209 (43.9%) named one challenge, 267 (56.1%) identified more than one. In total, 955 challenges were identified with the most frequently cited being physical (n = 462, 48.4%) and psychological (n = 234, 24.5%). A total of 391 survivors wrote 679 suggestions about improvements in care with the majority (n = 248, 69.4%) offering more than one. The most frequently cited suggestions included information/communication (n = 191, 29.8%), naming a range of topics for which information was desired, and access to post-treatment therapies/services (n = 164, 25.5%) such as counseling, physiotherapy, and occupational therapy. The overarching theme was, "I need follow-up care that fits me." Conclusions: AYA cancer survivors are diverse and face unique challenges following treatment, which can have life-long implications and impede their recovery. Personalized follow-up care is highly recommended by these survivors.
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Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Irene Nicoll
- Department of Health Policy and Biostatistics, University of Toronto, Toronto, Canada
| | - Gina Lockwood
- Department of Health Policy and Biostatistics, University of Toronto, Toronto, Canada
| | - Raymond J Chan
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,Department of Pediatrics and Oncology, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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18
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Jones JM, Fitch M, Bongard J, Maganti M, Gupta A, D’Agostino N, Korenblum C. The Needs and Experiences of Post-Treatment Adolescent and Young Adult Cancer Survivors. J Clin Med 2020; 9:jcm9051444. [PMID: 32413981 PMCID: PMC7291222 DOI: 10.3390/jcm9051444] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Adolescents and young adults (AYAs) who have been diagnosed with and treated for cancer have unique healthcare needs, but more research is needed to inform developmentally targeted cancer care for this population. The purpose of the current analyses was to describe the physical and psychosocial concerns and experiences of AYA cancer survivors during the post-treatment phase. (2) Methods: A national survey was conducted by the Canadian Partnership Against Cancer to evaluate the experiences and unmet needs of cancer survivors (≥18 years) within the first 5 years following cancer treatment. The current analyses were conducted on the AYA survivor population (18-34 years). (3) Results: A total of 575 surveys were completed by AYAs. Of these, 61% were female, 51% were married/partnered, and 52% were 1-3 years post treatment. Approximately three-quarters report their physical or emotional health as good/very good. Overall, 88% reported at least one physical concern [mean of 3.98+2.11 physical concerns (range 0-9)], 90% reported at least one emotional concern [mean of 3.77+1.75 emotional concern (range 0-6)], and 79% reported at least one practical challenge [mean of 2.39+1.28 practical concerns (range 0-5)]. The most common concerns were anxiety/worry about cancer returning (83%), fatigue/tiredness (78%), and depression/loss of interest in daily activities (66%). On average, 43% of those reporting a concern sought help. Common reasons for not seeking help included not wanting to ask, being told that it was normal to feel the way they did, or embarrassment. Of those who did seek help, 37% encountered difficulty obtaining assistance. (4) Conclusions: These results suggest that post-treatment AYA cancer survivors have a high rate and number of physical, psychosocial, and practical concerns and are often not seeking or receiving help to address these. Proactive approaches to characterizing and eliminating barriers to obtaining appropriate care are needed.
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Affiliation(s)
- Jennifer M Jones
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada;
- Correspondence: ; Tel.: +1-416-581-8603
| | - Margaret Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada;
| | - Jared Bongard
- Cancer Rehabilitation and Survivorship, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada;
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada;
| | - Abha Gupta
- Division of Hematology/Oncology, SickKids Hospital Toronto, Ontario, ON M5G 1X8, Canada;
- Adolescent & Young Adult Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Norma D’Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada (C.K.)
| | - Chana Korenblum
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada (C.K.)
- Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital, Toronto, ON M5G 1X8, Canada
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19
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Rae CS, Tsangaris E, Klassen AF, Breakey V, D'Agostino N. Comparison of Patient-Reported Outcome Measures for Use as Performance Metrics in Adolescent and Young Adult Psychosocial Cancer Care. J Adolesc Young Adult Oncol 2020; 9:262-270. [DOI: 10.1089/jayao.2019.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Charlene S. Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Vicky Breakey
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Canada
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20
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Psychosocial assessment of families caring for a child with acute lymphoblastic leukemia, epilepsy or asthma: Psychosocial risk as network of interacting symptoms. PLoS One 2020; 15:e0230194. [PMID: 32203535 PMCID: PMC7089558 DOI: 10.1371/journal.pone.0230194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/24/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study is to assess psychosocial risk across several pediatric medical conditions and test the hypothesis that different severe or chronic pediatric illnesses are characterized by disease specific enhanced psychosocial risk and that risk is driven by disease specific connectivity and interdependencies among various domains of psychosocial function using the Psychosocial Assessment Tool (PAT). In a multicenter prospective cohort study of 195 patients, aged 5–12, 90 diagnosed with acute lymphoblastic leukemia (ALL), 42 with epilepsy and 63 with asthma, parents completed the PAT2.0 or the PAT2.0 generic version. Multivariate analysis was performed with disease as factor and age as covariate. Graph theory and network analysis was employed to study the connectivity and interdependencies among subscales of the PAT while data-driven cluster analysis was used to test whether common patterns of risk exist among the various diseases. Using a network modelling approach analysis, we observed unique patterns of interconnected domains of psychosocial factors. Each pathology was characterized by different interdependencies among the most central and most connected domains. Furthermore, data-driven cluster analysis resulted in two clusters: patients with ALL (89%) mostly belonged to cluster 1, while patients with epilepsy and asthma belonged primarily to cluster 2 (83% and 82% respectively). In sum, implementing a network approach improves our comprehension concerning the character of the problems central to the development of psychosocial difficulties. Therapy directed at problems related to the most central domain(s) constitutes the more rational one because such an approach will inevitably carry over to other domains that depend on the more central function.
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21
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Rohan JM, Verma T. Psychological Considerations in Pediatric Chronic Illness: Case Examples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051644. [PMID: 32138373 PMCID: PMC7084293 DOI: 10.3390/ijerph17051644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
Despite significant gains in survival rates for pediatric patients and adolescents/young adults (AYA) with chronic illness, patients in this vulnerable age group are also at an increased risk for developing one or more adverse effects related to their disease, treatment, or maladaptive health behaviors. Maladaptive health behaviors ultimately increase the risk for developing adverse effects, including: increased rates of morbidity and mortality, impaired physical functioning, increased fatigue, obesity, increased psychological distress, and poor quality of life. With close attention including participation in preventive and therapeutic health promotion interventions, problematic health behaviors can be mitigated and ultimately prevented over time. It is well known that improved psychological functioning and adaptive coping can result in improved health status. The present paper provides four case examples illustrating various psychological interventions in pediatric chronic illness. As evidenced in the four case examples, pediatric psychologists provide comprehensive interventions for patients with acute and chronic medical conditions through the use of health promotion interventions, adherence and self-management promotion, cognitive behavioral therapy, behavioral therapy, medical coping, parent training, and motivational interviewing. Our case series demonstrates that for the most impactful behavior change to occur, a combination of interventions is often the most effective.
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Affiliation(s)
- Jennifer M. Rohan
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA;
- Cancer Prevention and Control Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23219, USA
- Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
- Correspondence:
| | - Tanvi Verma
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA;
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22
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Rae C, Shah N, De Pauw S, Costa A, Barr RD. System Performance Indicators for Adolescent and Young Adult Cancer Care and Control: A Scoping Review. J Adolesc Young Adult Oncol 2020; 9:1-11. [DOI: 10.1089/jayao.2019.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nishwa Shah
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonja De Pauw
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Costa
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronald D. Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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23
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Gittzus JA, Fasciano KM, Block SD, Mack JW. Peace of mind among adolescents and young adults with cancer. Psychooncology 2019; 29:572-578. [PMID: 31825157 DOI: 10.1002/pon.5309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) with cancer have high rates of psychological distress and unmet support needs. Peace of mind is an important construct among older cancer patients and parents of children with cancer but has not been explored in AYAs. We sought to evaluate the extent to which AYAs with cancer experience peace of mind and to identify factors associated with greater peace of mind. METHODS We surveyed 193 AYAs with cancer aged 15 to 29 years within 12 weeks of diagnosis; 137 patients completed the same measures again 4 and 12 months after diagnosis. Patients were asked to report peace of mind, measured using items from the Functional Assessment of Chronic Illness, Spiritual Well-being scale (FACIT-Sp); anxiety and depression, using the Hospital Anxiety and Depression Scale (HADS); and experiences surrounding medical communication and decision making. RESULTS Mean scores for peace of mind were 3.59 at diagnosis (range 1-5, standard deviation 0.84), with similar scores at 4 (3.53, P = .34) and 12 (3.59, P = .94) months. In a multivariable model adjusted for age and gender, patients who reported receiving high-quality information about their cancer had greater peace of mind at diagnosis (β = .25, P = .03), whereas those who reported holding a passive role in treatment decision making (β = -.47, P < .0001) or who had anxiety (β = -.64, P = .0003) or depression (β = -.51, P = .04) had lower peace of mind. CONCLUSION Peace of mind did not improve significantly over time for AYAs with cancer. While high-quality communication may be associated with heightened peace of mind, further study is needed to clarify relationships between peace of mind and other psychological variables.
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Affiliation(s)
- Jordan A Gittzus
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Karen M Fasciano
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan D Block
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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Borgmann‐Staudt A, Kunstreich M, Schilling R, Balcerek M, Dirksen U, Cario H, Kepakova K, Klco‐Brosius S, Korte E, Kruseova J, Lackner H, Langer T, Roslan K, Stefanowicz J, Strauß G, Byrne J. Fertility knowledge and associated empowerment following an educational intervention for adolescent cancer patients. Psychooncology 2019; 28:2218-2225. [DOI: 10.1002/pon.5210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Marina Kunstreich
- Department of Paediatric Oncology, Haematology and ImmunologyMedical FacultyHeinrich‐Heine‐University of Düsseldorf Düsseldorf Germany
| | | | - Magdalena Balcerek
- Charité‐Universitätsmedizin Berlin Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
| | - Uta Dirksen
- University Hospital Essen Pediatrics IIIWest German Cancer Centre Essen Germany
- German Cancer Research Centre (DKTK) Heidelberg Germany
| | - Holger Cario
- Department of Pediatrics and Adolescent MedicineUniversity Medical Center Ulm Ulm Germany
| | - Katerina Kepakova
- University Hospital Brno and International Clinical Research Centre (FNUSA‐ICRC)Masaryk University Brno Czech Republic
| | | | | | | | | | | | | | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and OncologyMedical University of Gdansk Gdańsk Poland
| | - Gabriele Strauß
- Helios Kliniken Berlin‐Buch, Klinik für Kinder‐ und Jugendmedizin Berlin Germany
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25
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Boles J, Daniels S. Researching the Experiences of Children with Cancer: Considerations for Practice. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E93. [PMID: 31426332 PMCID: PMC6721372 DOI: 10.3390/children6080093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/16/2022]
Abstract
Children and adolescents with cancer often participate in medical and psychosocial research throughout their diagnosis and treatment. Furthermore, this involvement frequently extends into the survivorship period. Sometimes referred to as "doubly vulnerable" research participants, children and adolescents with cancer are not only minors, but also minors facing significant medical, developmental, and psychosocial stressors associated with chronic illness. Thus, it is important to exercise care in designing and conducting research with this population; however, these considerations have not been adequately addressed in pediatric healthcare literature. Therefore, the purpose of this review is to describe the research preferences and experiences of children and adolescents with cancer to identify techniques for supporting this population as research participants. By incorporating developmentally appropriate, context-specific, and child-centered adjustments, researchers can help children and adolescents with cancer effectively and meaningfully describe their illness experiences while also developing a positive outlook on future research participation.
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Affiliation(s)
- Jessika Boles
- Child Life Services, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232, USA.
| | - Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, Memphis, TN 38163, USA
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26
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Ricadat É, Schwering KL, Fradkin S, Boissel N, Aujoulat I. Adolescents and young adults with cancer: How multidisciplinary health care teams adapt their practices to better meet their specific needs. Psychooncology 2019; 28:1576-1582. [PMID: 31145822 DOI: 10.1002/pon.5135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/02/2019] [Accepted: 05/09/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Dedicated adolescent and young adult (AYA) cancer units have emerged from the early 1990s to address multiple challenges faced by AYA patients with cancer. Specific needs of AYA patients have been considered in an increasing number of studies. However, few describe how the health care professionals (HCPs) perceive their patients' needs and how they actually adjust their day-to-day practices to meet such needs. The purpose of this study is to identify and describe the practical methods of care and teamwork implemented by HCPs in response to what they perceive as essential to support psychosocial development of AYA patients. METHODS Qualitative research was conducted between 2012 and 2014 with 31 HCPs from a recently created haematology AYA unit in France. The transcripts of open-ended interviews were subject to inductive analysis using constant comparison as recommended by the grounded theory methods. RESULTS Our results show how HCPs adapt their practices and care relationships to support three major developmental milestones related to identity construction in AYAs: self-determination and individuation from parents, gender and sexual identity, and social life and connectedness to peers and adults (other than parents). Our results also show how HCPs adapt their practices and organisational methods to enhance the flexibility required to address their young patients, thus setting consistent and high standards for the whole team. Such adaptation is made possible through collaborative work and collective processes that facilitate self-reflection. CONCLUSIONS Our findings shed light on some meaningful young patient-friendly practices of care and advocate for AYA-dedicated units.
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Affiliation(s)
- Élise Ricadat
- IHSS/CRPMS/IUH,"La personne en médecine" (ANR-18-IDEX-0001), Université de Paris, Paris, France
| | | | - Sophie Fradkin
- IHSS/CRPMS/IUH,"La personne en médecine" (ANR-18-IDEX-0001), Université de Paris, Paris, France
| | - Nicolas Boissel
- Haematology AYA Unit, Saint-Louis Hospital, APHP, EA-3518, Université de Paris, Paris, France
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Reblin M, Stanley NB, Galligan A, Reed D, Quinn GP. Family dynamics in young adult cancer caregiving: “It should be teamwork”. J Psychosoc Oncol 2019; 37:526-540. [DOI: 10.1080/07347332.2018.1563582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Nathanael B. Stanley
- Moffitt Cancer Center, Tampa, Florida, USA
- University of South Florida, Tampa, Florida, USA
| | | | - Damon Reed
- Moffitt Cancer Center, Tampa, Florida, USA
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Elsbernd A, Crenner C, Rosell T, Panicker J. Individual Experiences and Utilization of Supportive Resources in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:329-334. [PMID: 30653388 DOI: 10.1089/jayao.2018.0107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Adolescents and young adults (AYAs) with cancer are often impacted by distress due to disease and treatment. Despite these concerns, prior research has found that AYAs do not utilize support resources, do not find these resources adequate, and or do not have adequate access to services. Objective: The objective of this project was to understand and identify AYA patient concerns and experiences throughout cancer treatment, what resources were utilized, how they were identified, and how supportive care resources for AYA cancer patients can be improved. Methods: Twenty-eight AYA cancer patients and survivors were interviewed on their experiences and utilization of supportive resources throughout cancer treatment. Qualitative data were analyzed using thematic analysis and organized through a priori framework examining specific domains of experience and resources utilized. Results: The most frequently discussed topic in qualitative interviews was the benefit of the health care team. Other frequently identified resources were generalized internet searches and webpages. Suggested unmet resource needs included supportive resources for family members and caregivers throughout the time of treatment. Conclusions: AYAs experience stress throughout treatment for cancer attributed to physical, practical, and psychosocial causes. Health care workers play a vital role in serving as an informative and supportive resource for their AYA patients. As such, health care workers and other supportive resources may alleviate these concerns, but these resources are still underexplored.
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Affiliation(s)
- Abbey Elsbernd
- 1 University of Kansas School of Medicine, Kansas City, Kansas
| | - Christopher Crenner
- 2 Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Tarris Rosell
- 2 Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Jyoti Panicker
- 3 Division of Hematology and Oncology, Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas
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Elsbernd A, Hjerming M, Visler C, Hjalgrim LL, Niemann CU, Boisen KA, Jakobsen J, Pappot H. Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study. JMIR Form Res 2018; 2:e23. [PMID: 30684439 PMCID: PMC6334689 DOI: 10.2196/formative.9842] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 01/08/2023] Open
Abstract
Background Adolescent and young adult (AYA) oncology and hematology is a developing field of medicine, focusing on a population that faces many challenges throughout medical treatment and beyond. Mobile health (mHealth) interventions provide exciting new opportunities for improvement of health-related quality of life (HRQoL) in AYAs with cancer. Many smartphone apps are currently available for AYAs with cancer; however, for AYAs with cancer, very few apps have been designed with direct input from AYAs themselves or have demonstrated their effectiveness and benefit. Objective The objective of this project was to develop the prototype of a smartphone app for AYAs with cancer through the process of cocreation, with the active input of AYAs who have received treatment for cancer directly impacting content and design. Methods Patients were recruited from a population of Danish AYAs who had received treatment for cancer between the ages of 15 and 29 years. The cocreation process was completed over the course of 3 workshops and intermittent ad hoc meetings, where the recruited AYAs worked in coordination with 1 nurse, 1 doctor, and 2 representatives from a digital agency and app developer. During each workshop, participants prioritized their goals for the app. After new app content was developed, feedback was requested from the participants, and changes were made accordingly. This iterative process continued until consensus on final product features and design were achieved. Health care professionals provided minimal input and primarily performed observational roles in the workshops, with direct interaction limited to introducing the project and explaining measurement features of the app in development. Results Three key features to be included in the prototype app were identified from the cocreation workshops: (1) a community forum; (2) an information library; and (3) a symptom and side-effect tracking tool. Bright, warm colors were selected for the app by the participating AYAs. The final prototype will be launched for pilot testing and implementation testing in February of 2018. Conclusions The process of cocreation is a user-involved process that can create an end product that is useful and customized for the target population. This process, as such, is a beneficial process to utilize when addressing the specific needs of AYAs with cancer. The results of the here described app prototype will be evaluated in more detail in the near future. However, this description of the cocreation process in app development can be utilized for the creation of other mHealth interventions.
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Affiliation(s)
- Abbey Elsbernd
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,University of Kansas School of Medicine, Kansas City, KS, United States
| | - Maiken Hjerming
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Visler
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Rosenberg AR, Bradford MC, McCauley E, Curtis JR, Wolfe J, Baker KS, Yi-Frazier JP. Promoting resilience in adolescents and young adults with cancer: Results from the PRISM randomized controlled trial. Cancer 2018; 124:3909-3917. [PMID: 30230531 DOI: 10.1002/cncr.31666] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/02/2018] [Accepted: 05/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk for poor psychosocial outcomes. This study aimed to determine whether a novel intervention targeting resilience resources would improve patient-reported resilience, quality of life, and psychological distress. METHODS In this parallel, phase 2 randomized controlled trial, English-speaking AYAs (12-25 years old) with cancer were randomized to the Promoting Resilience in Stress Management (PRISM) intervention or usual care (UC). PRISM is a brief, skills-based intervention targeting stress management, goal setting, cognitive reframing, and meaning making. Participants completed surveys at enrollment and 6 months. Mixed effects regression models evaluated associations between PRISM and the primary outcome (10-item Connor-Davidson Resilience Scale scores) and secondary outcomes (generic and cancer-related quality of life [Pediatric Quality of Life modules], psychological distress [Kessler-6], and anxiety/depression [Hospital Anxiety and Depression]) at 6 months. RESULTS Ninety-two AYAs were enrolled, were randomized, and completed baseline surveys (48 in the PRISM group and 44 in the UC group); 73% were 12 to 17 years old, and 62% had leukemia or lymphoma. Attrition was primarily due to medical complications and/or death; 36 PRISM participants and 38 UC participants completed 6-month surveys. PRISM was associated with improved resilience (+3.0 points; 95% confidence interval [CI], 0.5-5.4; P = .02) and cancer-specific quality of life (+9.6; 95% CI, 2.6-16.7; P = .01) and reduced psychological distress (-2.1; 95% CI, -4.1 to -0.2; P = .03) but not generic quality of life (+7.2; 95% CI, -0.8 to 15.2; P = .08). Although anxiety was similar between the groups, 2 PRISM participants (6%) and 8 UC participants (21%) met the criteria for depression at 6 months (odds ratio, 0.09; 95% CI, 0.01-1.09; P = .06). CONCLUSIONS PRISM was associated with improved psychosocial outcomes in comparison with UC, suggesting that brief, skills-based interventions for AYAs may provide a benefit.
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Affiliation(s)
- Abby R Rosenberg
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Miranda C Bradford
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, Seattle, Washington.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - K Scott Baker
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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McCann L, McMillan KA, Hewitt C. An e-Prehabilitation System of Care for Teenagers and Young Adults Diagnosed With Cancer: Protocol for a Qualitative Co-Design Study. JMIR Res Protoc 2018; 7:e10287. [PMID: 30209030 PMCID: PMC6231758 DOI: 10.2196/10287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/29/2018] [Accepted: 06/19/2018] [Indexed: 11/24/2022] Open
Abstract
Background A diagnosis of cancer in young adulthood can pose many different and unique challenges for individuals. The provision of adequate and appropriate information as well as care and support for teenagers and young adults at the time of diagnosis is central to their health care experience going forward. Moreover, appropriate and accessible information provision is critical to ensure that young individuals with cancer feel equipped and empowered to make decisions about, and be involved in, their treatment and recovery throughout their experience; this is a concept known as prehabilitation. As digital interventions and resources that support teenagers and young adults with cancer are an increasingly desirable part of health care provision, this study will focus on the development of an age- and population-appropriate electronic prehabilitation (e-Prehabilitation) system of care. Objective We will conduct an exploratory, co-design research project that will inform the development of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. A collaborative approach to data collection and prototype design will ensure that a patient-centered approach is embedded throughout. Methods A qualitative, co-design study utilizing surveys, interviews, and focus group discussions is being conducted with teenagers and young adults, health care professionals, and technologists. Results This research study is in progress; recruitment and data collection activities have commenced and findings are expected in early 2019. Conclusions The findings of this study will have important implications for informing the future development and evaluation of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. Registered Report Identifier RR1-10.2196/10287
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Affiliation(s)
- Lisa McCann
- Digital Health & Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Kathryn A McMillan
- Digital Health & Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Christopher Hewitt
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
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Wu YP, Linder LA, Kanokvimankul P, Fowler B, Parsons BG, Macpherson CF, Johnson RH. Use of a Smartphone Application for Prompting Oral Medication Adherence Among Adolescents and Young Adults With Cancer. Oncol Nurs Forum 2018; 45:69-76. [PMID: 29251285 DOI: 10.1188/18.onf.69-76] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To explore the feasibility and acceptability of use of a smartphone medication reminder application to promote adherence to oral medications among adolescents and young adults (AYAs) with cancer.
. SAMPLE & SETTING 23 AYAs with cancer from a Children's Oncology Group-affiliated children's hospital and a National Cancer Institute-designated comprehensive cancer center in Salt Lake City, UT.
. METHODS & VARIABLES Participants were asked to use the application for eight weeks. Data on application usage were obtained from a cloud-based server hosted by the application developers. Weekly self-report questionnaires were completed. Feasibility was assessed through participants' usage and responses. Acceptability was assessed through participants' perceived ease of use and usefulness.
. RESULTS Almost all participants used the application at least once. More than half reported that they took their medications immediately when they received reminders. Participants also reported that the application was easy to set up and use, and that it was useful for prompting medication taking.
. IMPLICATIONS FOR NURSING Nurses could continue to test the efficacy of integrating e-health modalities, such as smartphone applications, into efforts to promote medication adherence.
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Affiliation(s)
| | | | | | | | | | | | - Rebecca H Johnson
- Mary Bridge Children's Hospital and Health Center/MultiCare Health System
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Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies. Blood 2018; 132:385-392. [DOI: 10.1182/blood-2017-11-778555] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/05/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
Adolescents and young adults (AYAs) occupy a unique place within the hematologic malignancy community due to the challenges they face related to their disease biology and physical, psychosocial, and economic circumstances, as well as issues related to access to care and long-term follow-up. Efforts to define age-specific (supportive) care needs and targets for intervention in these areas are evolving. This review discusses the psychosocial issues AYAs with hematologic malignancies are dealing with, how these might affect their health-related quality of life, and the challenges in delivering high-quality supportive care to this underserved population.
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Bell CJ, Bell RA, Zebrack B, Kato I, Morse A, Borinstein SC. Measuring Development of Adolescent and Young Adult Cancer Patients: An Integrative Review of Available Instruments. J Adolesc Young Adult Oncol 2018; 7:270-282. [DOI: 10.1089/jayao.2017.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cynthia J. Bell
- College of Nursing, Wayne State University, Detroit, Michigan
| | | | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Ikuko Kato
- Department of Oncology and Pathology, Wayne State University School of Medicine, Detroit, Michigan
| | - Alyssa Morse
- College of Nursing, Wayne State University, Detroit, Michigan
| | - Scott C. Borinstein
- Department of Pediatrics, Division of Hematology Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
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Elsbernd A, Hjerming M, Visler C, Hjalgrim LL, Niemann CU, Boisen K, Pappot H. Cocreated Smartphone App to Improve the Quality of Life of Adolescents and Young Adults with Cancer (Kræftværket): Protocol for a Quantitative and Qualitative Evaluation. JMIR Res Protoc 2018; 7:e10098. [PMID: 29748162 PMCID: PMC5980487 DOI: 10.2196/10098] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adolescents and young adults with cancer face significant challenges during the course of their medical treatment and recovery from illness. Many adolescents and young adults struggle with long-term complications in the physical, psychosocial, economic, and academic domains. Mobile health (mHealth) interventions provide an innovative platform for delivering supportive care, particularly through the utilization of apps on smartphones and tablets. To create a successful mHealth intervention for adolescents and young adults, youth input and feedback is essential. The process of cocreation, in which the target app user has a direct role in dictating design and function, was utilized to create the prototype smartphone app for adolescents and young adults with cancer, "Kræftværket." OBJECTIVE The objective of this paper is to describe the protocol for the evaluation of the Kræftværket app, a prototype app designed via cocreation, to support and improve health-related quality of life for adolescents and young adults with cancer. METHODS The Kræftværket app has three primary features, (1) a symptom and activity diary, (2) a supportive communication network between app users, and (3) a "one-stop shop" information bank with practical information as well as links to patient organizations and other resources. The app will be evaluated in two phases, a pilot test and an implementation test. In the pilot test, the app will be launched to a test group of 20 adolescents and young adults aged 15 to 29 years, selected for equal representation amongst age group and treatment status. Patients will be allowed to utilize the app over the course of six weeks and will complete a baseline and follow-up European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) health-related quality of life inventory. In addition, participant focus group interviews will be conducted according to a semistructured interview guide. Resulting data will be analyzed using thematic analysis. Results and appropriate analysis from both the qualitative and quantitative branches of the pilot test will be discussed amongst the research group, and appropriate changes based on user feedback will be made to the app before the final project phase. In the implementation test, the app will be provided and utilized by a sample of 50 adolescents and young adults aged 15-29 years selected for equal representation amongst gender, age group, diagnosis, and treatment status over the course of 3 months. Participants will be asked to complete a baseline and follow-up EORTC QLQ-C30 HRQoL inventory. RESULTS Pilot testing is expected to take place in February 2018, and implementation testing is expected to begin May 2018. CONCLUSIONS It is the hope that Kræftværket app will serve as a beneficial and easily utilized product. The process of evaluating the app and its effect on quality of life will address the absence of evidence-based mHealth interventions, and attempt to validate new approaches to benefitting adolescents and young adult oncology patients in the digital world. REGISTERED REPORT IDENTIFIER RR1-10.2196/10098.
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Affiliation(s)
- Abbey Elsbernd
- School of Medicine, University of Kansas, Kansas City, KS, United States.,Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maiken Hjerming
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Visler
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Pediatric Hematology and Oncology, The Child and Youth Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Boisen
- Center for Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Fisher PL, McNicol K, Cherry MG, Young B, Smith E, Abbey G, Salmon P. The association of metacognitive beliefs with emotional distress and trauma symptoms in adolescent and young adult survivors of cancer. J Psychosoc Oncol 2018; 36:545-556. [PMID: 29611779 DOI: 10.1080/07347332.2018.1440276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE/OBJECTIVES Adolescent and young adults who have survived cancer are at an increased risk of psychological distress. This study investigated whether metacognitive beliefs are associated with emotional distress and trauma symptoms in adolescent and young adult (AYA) survivors of cancer independent of known covariates, including current physical health difficulties. DESIGN Cross-sectional survey using multiple self-report measures. SAMPLE AND METHODS Eighty-seven AYA survivors of cancer were recruited from follow-up appointments at an oncology unit and completed self-report questionnaires measuring emotional distress, posttraumatic stress symptoms, metacognitive beliefs, demographic information, and current physical health difficulties. Data were analysed using correlational and hierarchical multiple regression analyses. FINDINGS Metacognitive beliefs explained an additional 50% and 41% of the variance in emotional distress and posttraumatic stress symptoms, respectively, after controlling for known covariate effects, including current physical health difficulties. Conclusions/Implications for Psychosocial Providers or Policy: The metacognitive model of psychopathology is potentially applicable to AYA survivors of cancer who present with elevated general distress and/or posttraumatic stress symptoms. Prospective studies are required to determine whether metacognitive beliefs and processes have a causal role in distress in AYA survivors of cancer.
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Affiliation(s)
- Peter L Fisher
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK.,b Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital , Liverpool , UK.,c Nidaros DPS, Division of Psychiatry, Ostmarka University Hospital , Trondheim , Norway
| | - Kirsten McNicol
- d Division of Clinical Psychology, University of Liverpool , Liverpool , UK
| | - Mary Gemma Cherry
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK.,b Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital , Liverpool , UK
| | - Bridget Young
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK
| | - Ed Smith
- e The Christie Hospital , Manchester , UK
| | - Gareth Abbey
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK
| | - Peter Salmon
- a Department of Psychological Sciences , University of Liverpool , Liverpool , UK.,b Liverpool Cancer Psychology Service, Linda McCartney Centre, Royal Liverpool University Hospital , Liverpool , UK
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Kosola S, McCarthy MC, McNeil R, Orme LM, Drew S, Sawyer SM. Early Education and Employment Outcomes After Cancer in Adolescents and Young Adults. J Adolesc Young Adult Oncol 2018; 7:238-244. [DOI: 10.1089/jayao.2017.0045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Silja Kosola
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Maria C. McCarthy
- Murdoch Children's Research Institute, Melbourne, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Robyn McNeil
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Lisa M. Orme
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sarah Drew
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Susan M. Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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A New Lease on Life: Preliminary Needs Assessment for the Development of a Survivorship Program for Young Adult Survivors of Cancer in South Texas. J Pediatr Hematol Oncol 2018; 40:e154-e158. [PMID: 28991132 PMCID: PMC5866154 DOI: 10.1097/mph.0000000000000990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Priorities for young adult survivorship care from the survivors' perspective are not well documented. To address this within our patient population, we conducted a multimethod needs assessment of young adult survivors of pediatric, adolescent, and young adult cancer in South Texas to get a better understanding of the ongoing challenges and priorities for their survivorship needs and related services. Participants were 18 to 39 years at the time of the needs assessment and predominately Hispanic. In an online survey, survivors most commonly cited being concerned about their physical and mental health, long-term treatment effects, recurrence, and health insurance issues. Participants stated that they received critical support from family, friends, and medical staff, but they would like to receive additional support from other cancer survivors through peer mentorship opportunities and survivor retreats/social events.
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Szalda D, Schapira MM, Jacobs LA, Palmer SC, Vachani C, Metz J, Hill-Kayser C. Survivorship Care Planning for Young Adults After Cancer Treatment: Understanding Care Patterns and Patient-Reported Outcomes. J Adolesc Young Adult Oncol 2018; 7:430-437. [PMID: 29570983 DOI: 10.1089/jayao.2017.0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Young adult survivors (YAS) of cancer experience late effects of treatment similar to older adult survivors (AS). Online health tools such as Internet-based survivorship care plans (SCPs) can provide access to information about late effects and symptom management, but little is known about SCP patterns of use among YAS. METHODS An Internet-based cross-sectional survey was completed over 24 months. Participants were individuals diagnosed with cancer between 18 and 39 years (YAS, n = 611) or 40-60 years (AS, n = 1742), who were 2-20 years postdiagnosis, and who created an Internet-based SCP. Demographics, treatment-related variables, satisfaction with SCP, communication of SCP, and patient-reported late effects (fatigue, neurocognitive, sexual, cardiovascular, pulmonary, or second cancers) were collected. RESULTS YAS were primarily female (71%), Caucasian (78%), college educated (65%), and generated the SCP without assistance (76%). YAS reported satisfaction with content (93%) and shared content with providers (71%). A higher proportion of YAS than AS were male (29% vs. 17%, p < 0.001), lived internationally (23% vs. 17%, p = 0.003), and endorsed oncologist-led survivorship care (47% vs. 41%, p = 0.001). YAS reported concerns about neurocognitive performance (56%) and fatigue (50%). Overall, YAS reported equivalent or fewer late effects than AS across all domains. CONCLUSIONS YAS report high satisfaction with the online SCP, as well as a high symptom burden, although the latter were reported less than for AS.
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Affiliation(s)
- Dava Szalda
- 1 Division of Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.,2 Division of Oncology, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Marilyn M Schapira
- 3 University of Pennsylvania Center for Health Equity Research & Promotion , Philadelphia, Pennsylvania
| | - Linda A Jacobs
- 1 Division of Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Steven C Palmer
- 1 Division of Oncology, Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Carolyn Vachani
- 4 Department of Radiation Oncology, Abramson Cancer Center, Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - James Metz
- 4 Department of Radiation Oncology, Abramson Cancer Center, Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Christine Hill-Kayser
- 2 Division of Oncology, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.,4 Department of Radiation Oncology, Abramson Cancer Center, Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania
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41
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Cook EE, MacMillan A, Gershman ST. Cancer Among Adolescents and Young Adults in Massachusetts from 2004 to 2014. J Adolesc Young Adult Oncol 2018; 7:493-498. [PMID: 29565711 DOI: 10.1089/jayao.2018.0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This brief report describes the burden of cancer among adolescents and young adults (AYAs), aged 15-39 years, in Massachusetts from 2004 to 2014 using data from the Massachusetts Cancer Registry and Registry of Vital Records and Statistics. In Massachusetts, 4.6% of cancer cases and 1.3% of cancer deaths occurred among AYAs. The incidence rate of cancer among AYAs was 77.6 cases per 100,000 and the mortality rate was 8.0 deaths per 100,000. The incidence rates of melanoma and Hodgkin lymphoma have been decreasing annually. The incidence rate of thyroid cancer has been increasing for females aged 15-24 years and males aged 25-39 years.
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Affiliation(s)
- Erin E Cook
- 1 Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, Massachusetts.,2 Massachusetts Department of Public Health, Massachusetts Cancer Registry , Boston, Massachusetts
| | - Annie MacMillan
- 2 Massachusetts Department of Public Health, Massachusetts Cancer Registry , Boston, Massachusetts
| | - Susan T Gershman
- 2 Massachusetts Department of Public Health, Massachusetts Cancer Registry , Boston, Massachusetts
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Lavi I, Fladeboe K, King K, Kawamura J, Friedman D, Compas B, Breiger D, Gurtovenko K, Lengua L, Katz LF. Stress and marital adjustment in families of children with cancer. Psychooncology 2018; 27:1244-1250. [PMID: 29405486 DOI: 10.1002/pon.4661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Pediatric cancer is highly stressful for parents. The current prospective study examines the impact of several stressors (financial strain, life threat, treatment intensity, treatment-related events, and negative life events) on the trajectory of marital adjustment across the first year following diagnosis. We examined whether average level of stressors across the year was related to (1) levels of marital adjustment at the end of the first year of treatment and () the rate of change in marital adjustment. METHOD One hundred and thirty families of children newly diagnosed with cancer (M age = 6.33 years, SD = 3.61) participated. Primary caregivers provided 12 monthly reports on marital adjustment and stressors. RESULTS Multilevel models indicated that although marital adjustment was stable across the first year on average, random effect estimates suggested that this was the result of differing trajectories between families (eg, some increasing and others decreasing). Five individual stress constructs and a cumulative stress composite were then used to predict this variability. Higher average economic strain was related to consistently poorer marital adjustment across time. Higher average frequency of treatment-related events and negative life events were associated with decreasing adjustment over time and lower adjustment at the end of the first year of treatment. Perception of life threat and treatment intensity were not associated with final levels or trajectory of adjustment. Finally, higher cumulative stress was associated with consistently poorer marital adjustment across time. CONCLUSION Implications for identification of at-risk families are discussed, and importance of delivering tailored interventions for this population.
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Affiliation(s)
- Iris Lavi
- The Center for Research and Study of the Family, School of Social Work, University of Haifa, Haifa, Israel
| | - Kaitlyn Fladeboe
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Kevin King
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Debra Friedman
- Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Bruce Compas
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Kyrill Gurtovenko
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Liliana Lengua
- Department of Psychology, University of Washington, Seattle, WA, USA
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Gonzales MJ, Gross DM, Cooke E. Psychosocial Aspects of Hematologic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Symptom Management and Psychosocial Needs of Adults With Acute Myeloid Leukemia During Induction Treatment: A Pilot Study. Cancer Nurs 2017; 40:E31-E38. [PMID: 27631113 DOI: 10.1097/ncc.0000000000000428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with a new diagnosis of acute myeloid leukemia (AML) are at risk of experiencing a high symptom burden due to the disease and its treatment, which includes a long period of hospitalization. OBJECTIVE The aim of this pilot work was to describe the multidimensional symptoms and health-related quality of life experienced by patients with a new diagnosis of AML across induction chemotherapy. METHODS A prospective, longitudinal descriptive study design was implemented to evaluate symptoms and health-related quality of life at the time of enrollment through 6 weeks postdiagnosis and identify who might be most at risk of experiencing high symptom burden. RESULTS A total of 19 participants were included in this analysis. Moderate to severe levels of distress were present in 25% to 50% of participants, depending on timing in treatment. Females and those with a previous history of a psychological disorder reported higher symptom burden during treatment. CONCLUSIONS Our findings indicate that adults with AML experience multiple distressing symptoms during the induction treatment. IMPLICATIONS FOR PRACTICE Timely routine multidimensional assessment of symptoms in individuals undergoing induction chemotherapy treatment for AML is critical as they may be experiencing multiple concurrent symptoms. Additional research to advance symptom assessment and amelioration of distressing symptoms to improve health-related quality of life is needed in this unique population.
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Thewes B, Kaal SEJ, Custers JAE, Manten-Horst E, Jansen R, Servaes P, van der Graaf WTA, Prins JB, Husson O. Prevalence and correlates of high fear of cancer recurrence in late adolescents and young adults consulting a specialist adolescent and young adult (AYA) cancer service. Support Care Cancer 2017; 26:1479-1487. [PMID: 29168035 PMCID: PMC5876258 DOI: 10.1007/s00520-017-3975-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE High fear of cancer recurrence (FCR) is a frequently reported problem among cancer patients. Previous research has shown that younger age is associated with higher levels of FCR. However, little attention has been given to date about how FCR manifests itself among adolescent and young adult (AYA) cancer patients. This study explores the prevalence, correlates of high FCR, and its association with HRQoL in cancer patients in their late adolescence or young adulthood. METHODS Seventy-three AYA cancer patients, aged 18-35 years at diagnosis, consulted the AYA team of the Radboud University Medical Center completed questionnaires including the Cancer Worry Scale (CWS), Quality of Life-Cancer Survivors (QOL-CS), and Hospital Anxiety and Depression Scale (HADS). Sociodemographic and medical data was collected by self-reported questionnaire. RESULTS Forty-five participants experienced high FCR (62%), which was higher than the 31-52% reported in previous studies among mixed adult cancer patient samples. Sociodemographic and medical variables were not associated with levels of FCR. High FCR was significantly associated with lower levels of social and psychological functioning and overall HRQoL and higher levels of anxiety and psychological distress. CONCLUSION Results illustrate that FCR is a significant problem among AYA cancer patients consulting an AYA team, with participants reporting higher levels of FCR than cancer patients of mixed ages. Health care providers should pay specific attention to this problem by screening and the provision of appropriate psychosocial care when needed.
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Affiliation(s)
- Belinda Thewes
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Suzanne E J Kaal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jose A E Custers
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Eveliene Manten-Horst
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rosemarie Jansen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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47
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Évolution de l’auto-efficacité, des émotions et du concept de soi chez des adolescents hospitalisés en hémato-oncologie pendant une intervention de musicothérapie interactive : une étude pilote. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0622-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tremolada M, Taverna L, Bonichini S, Basso G, Pillon M. Self-Esteem and Academic Difficulties in Preadolescents and Adolescents Healed from Paediatric Leukaemia. Cancers (Basel) 2017; 9:E55. [PMID: 28538707 PMCID: PMC5483874 DOI: 10.3390/cancers9060055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/14/2017] [Accepted: 05/22/2017] [Indexed: 01/16/2023] Open
Abstract
Adolescents with cancer may demonstrate problems in their self-esteem and schooling. This study aims to screen the preadolescents and adolescents more at risk in their self-esteem perception and schooling difficulties post-five years from the end of therapy. Twenty-five paediatric ex-patients healed from leukaemia were recruited at the Haematology-Oncologic Clinic (University of Padua). The mean age of the children was 13.64 years (Standard Deviation (SD)) = 3.08, range = 10-19 years), most were treated for acute lymphoblastic leukaemia (ALL) (84%) and relatively equally distributed by gender. They filled in the Multidimensional Self-Esteem Test, while parents completed a questionnaire on their child's schooling. Global self-esteem was mostly below the 50 percentile (58.5%), especially regarding interpersonal relationships (75%). An independent sample t-test showed significant mean differences on the emotionality scale (t = 2.23; degree of freedom (df) = 24; p = 0.03) and in the bodily experience scale (t = 3.02; df = 24; p = 0.006) with survivors of Acute Myeloid Leukaemia (AML) having lower scores. An Analysis of Variance (ANOVA) showed significant mean differences in the bodily experience scale (F = 12.31; df = 2, p = 0.0001) depending on the survivors' assigned risk band. The parent reports showed that 43.5% of children had difficulties at school. Childhood AML survivors with a high-risk treatment were more at risk in their self-esteem perceptions. Preventive interventions focusing on self-esteem and scholastic wellbeing are suggested in order to help their return to their normal schedules.
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Affiliation(s)
- Marta Tremolada
- Department of Developmental and Social Psychology, University of Padua, Padua 35131, Italy.
| | - Livia Taverna
- Faculty of Education, Free University of Bozen-Bolzano, Brixen-Bressanone 39042, Italy.
| | - Sabrina Bonichini
- Department of Developmental and Social Psychology, University of Padua, Padua 35131, Italy.
| | - Giuseppe Basso
- Department of Child and Woman Health, Oncology Hematology Division, University-Hospital of Padua, Padua 35127, Italy.
| | - Marta Pillon
- Department of Child and Woman Health, Oncology Hematology Division, University-Hospital of Padua, Padua 35127, Italy.
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Husson O, Zebrack BJ, Aguilar C, Hayes-Lattin B, Cole S. Cancer in adolescents and young adults: Who remains at risk of poor social functioning over time? Cancer 2017; 123:2743-2751. [DOI: 10.1002/cncr.30656] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/18/2017] [Accepted: 02/07/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Olga Husson
- Department of Medical Psychology; Radboud University Medical Center; Nijmegen the Netherlands
| | | | - Christine Aguilar
- Division of Pediatric Hematology/Oncology; University of Texas Health Science Center at San Antonio; San Antonio Texas
| | | | - Steve Cole
- HopeLab Foundation; Redwood City California
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Breuer N, Sender A, Daneck L, Mentschke L, Leuteritz K, Friedrich M, Nowe E, Stöbel-Richter Y, Geue K. How do young adults with cancer perceive social support? A qualitative study. J Psychosoc Oncol 2017; 35:292-308. [PMID: 28145814 DOI: 10.1080/07347332.2017.1289290] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The social support of adolescents and young adults (AYA) has been studied very little. 18 interviews were conducted and evaluated with content analysis (inter-rater reliability = 0.87). All of the young adult cancer patients interviewed reported having received social support from at least two people (family, friends, and/or partner). Forms of emotional and instrumental support were more often reported than informational support. 12 participants described having received nonhelpful support, especially in areas of dealing with their situation, limited social participation, and distancing of friends. The participants considered social exchanges with other young adult cancer patients an important source of social support. AYA cancer patient networking should be improved.
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Affiliation(s)
- Nora Breuer
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Annekathrin Sender
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Lisa Daneck
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Lisa Mentschke
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Katja Leuteritz
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Michael Friedrich
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Erik Nowe
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
| | - Yve Stöbel-Richter
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany.,b Faculty of Management and Cultural Sciences , University of Zittau/Görlitz , Görlitz , Germany
| | - Kristina Geue
- a Department of Medical Psychology and Medical Sociology , Universitätsklinikum Leipzig , Leipzig , Germany
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