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Wakefield CE, Sansom-Daly UM, McGill BC, Hetherington K, Ellis SJ, Robertson EG, Donoghoe MW, McCarthy M, Kelada L, Girgis A, King M, Grootenhuis M, Anazodo A, Patterson P, Lowe C, Dalla-Pozza L, Miles G, Cohn RJ. Providing Psychological Support to Parents of Childhood Cancer Survivors: ' Cascade' Intervention Trial Results and Lessons for the Future. Cancers (Basel) 2021; 13:cancers13225597. [PMID: 34830752 PMCID: PMC8615912 DOI: 10.3390/cancers13225597] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary We assessed a new group-based cognitive behavior therapy videoconferencing program to support parents of childhood cancer survivors. The trial allocated parents to three groups: Cascade, peer-support, waitlist. Cascade achieved good parent engagement. We successfully delivered Cascade to participants who lived >3200 km apart. Any technical difficulties caused only minor disruptions. Most Cascade parents were satisfied and reported experiencing benefits from the program. However, Cascade did not improve our main outcomes, including parents’ quality of life, depression and anxiety. Cascade parents reported a short-term improvement in their confidence to use the skills they learnt, but this did not translate into actual use. After six months, Cascade parents felt their child survivor had lower psychological health than waitlisted parents. Our findings show that while some parents find Cascade helpful, it may not suit everyone. We used these findings to further improve Cascade and will trial the new version in future. Abstract We conducted a three-armed trial to assess Cascade, a four-module group videoconferencing cognitive behavior therapy (CBT) intervention for parents of childhood cancer survivors currently aged <18 years. We allocated parents to Cascade, an attention control (peer-support group), or a waitlist. The primary outcome was parents’ health-related quality of life (PedsQL-Family Impact/EQ-5D-5L) six months post-intervention. Parents also reported their anxiety/depression, parenting self-agency, fear of recurrence, health service and psychotropic medication use, engagement in productive activities, confidence to use, and actual use of, CBT skills, and their child’s quality of life. Seventy-six parents opted in; 56 commenced the trial. Cascade achieved good parent engagement and most Cascade parents were satisfied and reported benefits. Some parents expressed concerns about the time burden and the group format. Most outcomes did not differ across trial arms. Cascade parents felt more confident to use more CBT skills than peer-support and waitlisted parents, but this did not lead to more use of CBT. Cascade parents reported lower psychosocial health scores for their child than waitlisted parents. Cascade parents’ health service use, psychotropic medication use, and days engaged in productive activities did not improve, despite some improvements in waitlisted parents. Our trial was difficult to implement, but participants were largely satisfied. Cascade did not improve most outcomes, possibly because many parents were functioning well pre-enrolment. We used these findings to improve Cascade and will trial the new version in future.
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Affiliation(s)
- Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Correspondence: ; Tel.: +61-(2)-9382-3113; Fax: +61-(2)-9382-1789
| | - Ursula M. Sansom-Daly
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Brittany C. McGill
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Kate Hetherington
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Sarah J. Ellis
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia;
| | - Eden G. Robertson
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Mark W. Donoghoe
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Maria McCarthy
- Clinical Sciences, Brain and Mind, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 2052, Australia
| | - Lauren Kelada
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Afaf Girgis
- South West Sydney Clinical Campuses, UNSW Medicine and Health, Sydney, NSW 2052, Australia;
| | - Madeleine King
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia;
| | - Martha Grootenhuis
- Princess Máxima Center for Pediatric Oncology, 3584 CT Utrecht, The Netherlands;
| | - Antoinette Anazodo
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Pandora Patterson
- Research, Evaluation and Social Policy Unit, Canteen, Newtown, NSW 2042, Australia;
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Cherie Lowe
- Queensland Children’s Cancer Centre, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia;
| | - Gordon Miles
- Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, WA 6009, Australia;
| | - Richard J. Cohn
- School of Women’s and Children’s Health, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; (U.M.S.-D.); (B.C.M.); (K.H.); (S.J.E.); (E.G.R.); (M.W.D.); (L.K.); (A.A.); (R.J.C.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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Venettacci O, Skull S. Positive impacts of a dedicated General Paediatrics "home" ward in a tertiary paediatric Australian hospital. J Paediatr Child Health 2021; 57:659-663. [PMID: 33319415 DOI: 10.1111/jpc.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/01/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Abstract
AIMS Whilst a centralised model of care intuitively makes sense and is advocated in other subspecialty areas of medicine, there is a paucity of supportive evidence for General Paediatrics. Following ward restructuring at our tertiary paediatric centre in preparation for the COVID-19 pandemic, a new dedicated General Paediatrics ward was established. We evaluated medical and nursing staff well-being, morale and perceived impacts on care after the ward's establishment. METHODS Experiences were sought from medical and nursing staff whom had worked across both previous wards caring for General Paediatrics patients, as well as the new dedicated General Paediatrics ward. Mandated responses used the format of much better, better, same, worse and much worse. RESULTS A total of 73/82 (89%) medical and nursing staff completed the survey. A greater than 90% improved or neutral response was noted for 31/35 (89%) questions. About 80% of staff reported the new dedicated General Paediatrics ward provided a better or much better team-based approach, time efficient approach and overall model of care. A much better or better response was reported for communication between medical and nursing staff in 68%, team comradery in 69%, supportive/helpful nursing staff in 74%, job stress level in 66% and staff morale in 60% of respondents. CONCLUSIONS Overwhelmingly positive responses from this study support a centralised or "home" ward model of care for General Paediatrics patients in a tertiary paediatric setting. Our findings may be relevant to General Paediatrics teams in other centres currently using multiple wards to manage their patients.
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Affiliation(s)
- Oliver Venettacci
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Australia
| | - Sue Skull
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Australia.,Department of Research, Child and Adolescent Health Service, Perth, Western Australia, Australia.,Division of Paediatrics and Child Health, University of Western Australia, Crawley, Western Australia, Australia
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Namisango E, Bristowe K, Murtagh FE, Downing J, Powell RA, Abas M, Lohfeld L, Ali Z, Atieno M, Haufiku D, Guma S, Luyirika EB, Mwangi-Powell FN, Higginson IJ, Harding R. Towards person-centred quality care for children with life-limiting and life-threatening illness: Self-reported symptoms, concerns and priority outcomes from a multi-country qualitative study. Palliat Med 2020; 34:319-335. [PMID: 32081084 DOI: 10.1177/0269216319900137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Paediatric life-limiting and life-threatening conditions (life-limiting conditions) place significant strain on children, families and health systems. Given high service use among this population, it is essential that care addresses their main symptoms and concerns. AIM This study aimed to identify the symptoms, concerns and other outcomes that matter to children with life-limiting conditions and their families in sub-Saharan Africa. SETTING AND PARTICIPANTS Cross-sectional qualitative study in Kenya, Namibia, South Africa and Uganda. Children/caregivers of children aged 0-17 years with life-limiting conditions were purposively sampled by age, sex and diagnosis. Children aged 7 and above self-reported; caregiver proxies reported for children below 7 and those aged 7 and above unable to self-report. RESULTS A total of 120 interviews were conducted with children with life-limiting conditions (n = 61; age range: 7-17 years), and where self-report was not possible, caregivers (n = 59) of children (age range: 0-17) were included. Conditions included advanced HIV (22%), cancer (19%), heart disease (16%) endocrine, blood and immune disorders (13%), neurological conditions (12%), sickle cell anaemia (10%) and renal disease (8%). Outcomes identified included physical concerns - pain and symptom distress; psycho-social concerns - family and social relationships, ability to engage with age-appropriate activities (e.g. play, school attendance); existential concerns - worry about death, and loss of ambitions; health care quality - child- and adolescent-friendly services. Priority psycho-social concerns and health service factors varied by age. CONCLUSION This study bridges an important knowledge gap regarding symptoms, concerns and outcomes that matter to children living with life-limiting conditions and their families and informs service development and evaluation.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Fliss Em Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,Wolfson Palliative Care Research Center, Hull York Medical School, Hull, UK
| | - Julia Downing
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.,International Children's Palliative Care Network, Assagay, South Africa.,Palliative Care Unit, Makerere University, Kampala, Uganda
| | | | - Melanie Abas
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lynne Lohfeld
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Zipporah Ali
- Kenya Hospice and Palliative Care Association, Nairobi, Kenya
| | | | | | | | | | | | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Marshall S, Grinyer A, Limmer M. The Experience of Adolescents and Young Adults Treated for Cancer in an Adult Setting: A Review of the Literature. J Adolesc Young Adult Oncol 2018; 7:283-291. [PMID: 29437492 DOI: 10.1089/jayao.2017.0123] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this review is to explore the literature on the experience of adolescents and young adults (AYAs) having cancer treatment in an adult setting, rather than on a specialist adolescent cancer unit. The integrative review method was used to explore the current literature. Primary research on the topic was located systematically and then synthesized into a thematic narrative. The experience of AYAs undergoing treatment in an adult setting was generally negative. This can be attributed to three themes: feeling isolated in the adult setting; the lack of empathy from staff working in the adult setting; and the inappropriateness of the adult environment for this age group. As many AYAs with cancer will continue to have treatment in adult settings, staff working in this environment should be aware of the negative experience of this cohort and the impact this can have on a vulnerable group of patients. Staff could consider simple ways of improving the AYA experience, such as connecting AYA patients with their peers to reduce isolation; adapting their approach to take account of the unique emotional needs of this age group; and considering ways of making the environment more welcoming and age-appropriate.
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Affiliation(s)
- Steve Marshall
- 1 Palliative Care Team, King's College Hospital NHS Foundation Trust, Cicely Saunders Institute , London, United Kingdom
| | - Anne Grinyer
- 2 Faculty of Health and Medicine, Furness College, Lancaster University , Lancaster, United Kingdom
| | - Mark Limmer
- 2 Faculty of Health and Medicine, Furness College, Lancaster University , Lancaster, United Kingdom
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Marshall S, Grinyer A, Limmer M. The 'lost tribe' reconsidered: Teenagers and young adults treated for cancer in adult settings in the UK. Eur J Oncol Nurs 2018; 33:85-90. [PMID: 29551183 DOI: 10.1016/j.ejon.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE Although the UK has pioneered the development of specialist adolescent cancer units, the majority of teenagers and young adults (TYAs) continue to be treated at their local hospital or at a cancer centre alongside adults of all ages. This study aimed to elicit young people's views on this experience of having cancer treatment in an adult setting. METHODS Seventeen participants who had been treated for cancer in an adult hospital between the ages of 15 and 24 were recruited via cancer charities and social media. Telephone interviews were conducted with the participants and the resulting data were analysed using thematic analysis. RESULTS Already feeling out of sync as a TYA with cancer, participants felt out of place in the adult setting. Four factors contributed to this negative experience: a lack of affinity with older patients; the challenging issues in the adult setting; the absence of empathy towards TYAs by staff; and the unsuitability of the environment for adolescents. CONCLUSION Staff working with TYAs with cancer in the adult setting should be aware of the potentially detrimental impact of this environment on this cohort of patients, and consider ways of adapting and modifying their approach.
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Affiliation(s)
- Steve Marshall
- Palliative Care Team, King's College Hospital NHS Foundation Trust, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, United Kingdom.
| | - Anne Grinyer
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, LA1 4YG, United Kingdom.
| | - Mark Limmer
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, LA1 4YG, United Kingdom.
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Pini SA, Gibson F, Fern LA, Morgan SJ, Phillips RS, Stark DP. Multi-Professional Perspectives on Adolescent and Young Adult Oncology Across Europe: An e-Delphi Survey. J Adolesc Young Adult Oncol 2017; 6:178-185. [PMID: 28080182 DOI: 10.1089/jayao.2016.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aims of this article are to describe the ongoing development of adolescent and young adult (AYA) cancer services within the European Union (EU), and to develop consensus on key areas within the field. This survey used an e-Delphi design. An initial survey was distributed via email to professionals working in Europe. A snowball sampling technique was used to promote distribution. Consensus was sought over three rounds from October 2012 to April 2015. Consensus was defined as >80% agreement ("agree" or "strongly agree"). Sixty professionals participated in round 1, 106 in round 2, and 61 in round 3. Twenty-six countries were represented across all rounds. Consensus was achieved for: the need for national policy guidance, the importance of patient choice, the validity of the International Charter of Rights for Young People, and some aspects of multi-disciplinary working. There was 75% agreement on a single definition of the patient age range within AYA cancer care. European professionals with expertise in AYA cancer care reached consensus on key elements of care for this group. The optimal AYA age range remained an elusive topic on which to agree. The broad engagement and interest in AYA cancer across the EU through the European Network for Cancer in Children and Adolescents (ENCCA) network was also demonstrated.
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Affiliation(s)
| | - Faith Gibson
- 2 Great Ormond Street Hospital for Children, NHS Foundation Trust and University of Surrey , London, United Kingdom
| | - Lorna A Fern
- 3 University College London Hospitals NHS Foundation Trust , London, United Kingdom
| | | | | | - Dan P Stark
- 1 St. James's Hospital , Leeds, United Kingdom
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Ferrari A, Silva M, Veneroni L, Magni C, Clerici CA, Meazza C, Terenziani M, Spreafico F, Chiaravalli S, Casanova M, Luksch R, Catania S, Schiavello E, Biassoni V, Podda M, Bergamaschi L, Puma N, Indini A, Proserpio T, Massimino M. Measuring the efficacy of a project for adolescents and young adults with cancer: A study from the Milan Youth Project. Pediatr Blood Cancer 2016; 63:2197-2204. [PMID: 27554940 DOI: 10.1002/pbc.26172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various projects dedicated specifically to adolescents and young adults (AYA) with cancer have been developed in recent years. A critical aspect of such programs is the ability to demonstrate its value, and therefore how to measure desired outcomes. METHODS A list of metrics to consider for demonstrating the advantages of an AYA program was identified and used to assess the activity of the Youth Project operating at the Pediatric Oncology Unit of the Istituto Nazionale Tumori in Milan. RESULTS The number of newly diagnosed AYA patients seen at the Unit has increased since the formal launch of the Youth Project, from 65 to 81.2 cases/year. Concerning the 78 AYA patients presenting with malignant neoplasms in 2015, 82% were included in clinical trials (the other 18% in prospective observational studies). Fertility preservation measures were implemented for 59% of AYA patients considered at risk, and specific psychological support was provided in 70.6% of cases; 72.5% of patients actively participated in support activities. Other parameters considered were a preliminary satisfaction questionnaire administered to patients and the program's scientific recognition and acknowledgment by the community. CONCLUSIONS The study proposed a number of potentially reproducible, practical parameters to consider in assessing the value of a program dedicated to AYA. These metrics were examined in terms of the activities of our Youth Project, and confirmed its efficacy. To be sustainable over time, AYA projects have to be accepted as a standard of care at the community and government levels.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy.
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Carlo Alfredo Clerici
- Clinical Biology, Oncology and Hemato-Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Alice Indini
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Tullio Proserpio
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
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Bibby H, White V, Thompson K, Anazodo A. What Are the Unmet Needs and Care Experiences of Adolescents and Young Adults with Cancer? A Systematic Review. J Adolesc Young Adult Oncol 2016; 6:6-30. [PMID: 27454408 DOI: 10.1089/jayao.2016.0012] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess what is currently known about unmet needs and care experiences of adolescents and young adults (AYAs) with cancer, identify gaps in the research literature, and highlight potential areas for improvement in future research. METHODS Medline, PsycINFO, CINAHL, and EMBASE databases were searched to identify relevant studies from 1990 to July 2015. Eligible articles included self-reported care experiences or unmet needs of cancer patients aged between 15 and 30 years in the period between symptom onset and 2 years post-treatment. Qualitative and quantitative designs were included. RESULTS Forty-five articles from 39 studies (23 qualitative, 12 quantitative, and 4 mixed methods) were rated as "adequate" or "good" quality and reviewed. The majority included any cancer diagnoses and none was longitudinal. There was considerable variation in age ranges and time since diagnosis between studies. Only two studies used standardized survey tools, with both tools validated on adult populations. The most common areas assessed for care experiences and needs were information/communication and fertility. In addition, care experience studies commonly examined clinical expertise and age-appropriate settings, while unmet needs studies reported on emotional support and peer interaction. CONCLUSION Findings highlight the need for age-appropriate information and treatment facilities, access to emotional support services, and contact with peers. Fertility information and services are a priority issue for this group. Future research would benefit from a consistent definition of the AYA age range, increased used of standardized scales validated with this population, and longitudinal designs to assess changes over time.
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Affiliation(s)
- Helen Bibby
- 1 Centre for Behavioural Research in Cancer , Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Victoria White
- 1 Centre for Behavioural Research in Cancer , Cancer Council Victoria, Melbourne, Victoria, Australia .,2 School of Psychological Sciences, University of Melbourne , Victoria, Australia
| | - Kate Thompson
- 3 ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Antoinette Anazodo
- 4 Sydney Youth Cancer Service, Sydney Children's and Prince of Wales Hospitals , Sydney, New South Wales, Australia
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Taylor RM, Fern LA, Solanki A, Hooker L, Carluccio A, Pye J, Jeans D, Frere-Smith T, Gibson F, Barber J, Raine R, Stark D, Feltbower R, Pearce S, Whelan JS. Development and validation of the BRIGHTLIGHT Survey, a patient-reported experience measure for young people with cancer. Health Qual Life Outcomes 2015; 13:107. [PMID: 26216214 PMCID: PMC4517652 DOI: 10.1186/s12955-015-0312-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient experience is increasingly used as an indicator of high quality care in addition to more traditional clinical end-points. Surveys are generally accepted as appropriate methodology to capture patient experience. No validated patient experience surveys exist specifically for adolescents and young adults (AYA) aged 13-24 years at diagnosis with cancer. This paper describes early work undertaken to develop and validate a descriptive patient experience survey for AYA with cancer that encompasses both their cancer experience and age-related issues. We aimed to develop, with young people, an experience survey meaningful and relevant to AYA to be used in a longitudinal cohort study (BRIGHTLIGHT), ensuring high levels of acceptability to maximise study retention. METHODS A three-stage approach was employed: Stage 1 involved developing a conceptual framework, conducting literature/Internet searches and establishing content validity of the survey; Stage 2 confirmed the acceptability of methods of administration and consisted of four focus groups involving 11 young people (14-25 years), three parents and two siblings; and Stage 3 established survey comprehension through telephone-administered cognitive interviews with a convenience sample of 23 young people aged 14-24 years. RESULT Stage 1: Two-hundred and thirty eight questions were developed from qualitative reports of young people's cancer and treatment-related experience. Stage 2: The focus groups identified three core themes: (i) issues directly affecting young people, e.g. impact of treatment-related fatigue on ability to complete survey; (ii) issues relevant to the actual survey, e.g. ability to answer questions anonymously; (iii) administration issues, e.g. confusing format in some supporting documents. Stage 3: Cognitive interviews indicated high levels of comprehension requiring minor survey amendments. CONCLUSION Collaborating with young people with cancer has enabled a survey of to be developed that is both meaningful to young people but also examines patient experience and outcomes associated with specialist cancer care. Engagement of young people throughout the survey development has ensured the content appropriately reflects their experience and is easily understood. The BRIGHTLIGHT survey was developed for a specific research project but has the potential to be used as a TYA cancer survey to assess patient experience and the care they receive.
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Affiliation(s)
- Rachel M Taylor
- Cancer Clinical Trials Unit University College London Hospitals NHS Foundation Trust, London, UK.
- School of Health & Social Care, London South Bank University, London, UK.
| | - Lorna A Fern
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Anita Solanki
- Cancer Clinical Trials Unit University College London Hospitals NHS Foundation Trust, London, UK.
| | - Louise Hooker
- University Hospitals of Southampton NHS Foundation Trust, Southampton, UK.
| | | | - Julia Pye
- Social Research Institute, Ipsos MORI, London, UK.
| | - David Jeans
- Social Research Institute, Ipsos MORI, London, UK.
| | | | - Faith Gibson
- School of Health & Social Care, London South Bank University, London, UK.
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK.
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK.
| | - Dan Stark
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.
| | - Richard Feltbower
- Division of Epidemiology & Biostatistics, School of Medicine, University of Leeds, Leeds, UK.
| | - Susie Pearce
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Jeremy S Whelan
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
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10
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Wilhelm M, Dirksen U, Bielack SS, Whelan JS, Lewis IJ, Jürgens H, Ferrari S, Sundby Hall K, Cleton-Jansen AM, Stark D. ENCCA WP17-WP7 consensus paper on teenagers and young adults (TYA) with bone sarcomas. Ann Oncol 2014; 25:1500-5. [PMID: 24962703 DOI: 10.1093/annonc/mdu153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Teenagers and young adults (TYA) cancer contributes substantially to morbidity and mortality in a population with much to offer society. TYA place distinct challenges upon cancer care services, many reporting feeling marginalized and their needs not being met in adult or paediatric cancer services. Bone tumours such as osteosarcoma and Ewing sarcoma, because of their age at presentation and the complexity of their care, are where challenges in managing (TYA) with cancer have often been most readily apparent. Bone sarcomas may be managed by paediatric or medical oncologists, and require fastidious attention to protocol. A lack of recent improvement in survival in TYA with bone tumours may be linked to a lack of specialist care, poor concordance with therapy in some situations and TYA-specific pharmacology. Participation in clinical trials, particularly of young adults, is low, hindering progress. All these requirements may be best met by a concerted effort to create collaborative care between adult and paediatric experts in bone sarcoma, working together to meet TYA patients' needs.
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Affiliation(s)
- M Wilhelm
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - U Dirksen
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S S Bielack
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - J S Whelan
- Teenage and Young Adult Unit, Department of Oncology, University College Hospital, London
| | - I J Lewis
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H Jürgens
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S Ferrari
- Italian Sarcoma Group (ISG), Chemioterapia, Bone Tumor Center, Istituto Rizzoli, Bologna, Italy
| | - K Sundby Hall
- Scandinavian Sarcoma Group (SSG), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A M Cleton-Jansen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Stark
- Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital Leeds, Leeds, UK
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11
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Götte M, Kesting S, Winter C, Rosenbaum D, Boos J. Comparison of self-reported physical activity in children and adolescents before and during cancer treatment. Pediatr Blood Cancer 2014; 61:1023-8. [PMID: 24357259 DOI: 10.1002/pbc.24898] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/19/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Physical activities are important for the development of children and increasing evidence suggests beneficial effects of physical activity promotion during cancer treatment as well. The present study aimed at evaluating the current need of exercise interventions in pediatric cancer patients undergoing acute treatment and identifying risk factors for inactivity. PROCEDURE Data about self-reported physical activity before and during treatment was collected in a cross-sectional design with the physical activity questionnaire from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) in a modified cancer specific version. RESULTS One hundred thirty pediatric cancer patients with various entities were questioned 3.0 ± 1.6 months since diagnosis. Patients' activity levels before diagnosis mainly matched reference values for healthy children in Germany. Reductions during treatment affected all dimensions of daily physical activities and minutes of exercise per week decreased significantly (P < 0.001). Largest reductions of physical activities during treatment were identified for bone tumor patients and in-patient stays. CONCLUSIONS Due to the well known importance of physical activity during childhood and the identified risk of inactivity during cancer treatment, supervised exercise interventions should be implemented into acute treatment phase to enhance activity levels and ensure a continuously support by qualified exercise professionals.
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Affiliation(s)
- Miriam Götte
- Department of Pediatric Hematology and Oncology, University Hospital of Muenster, Muenster, Germany
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Abstract
Adolescents and young adults (AYAs) have lower rates of clinical trial enrollment than younger or older patients with cancer. Multiple approaches to change policy and practice need to be used to improve this statistic. This article examines the option of increasing referral to 3 types of centers that are known to have relatively higher rates of enrollment of AYAs: pediatric cancer centers, AYA oncology programs, and National Cancer Institute-designated cancer centers. There are reasonable challenges to changing referral patterns, and more research, as well as education of those diagnosing AYAs, is required.
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Affiliation(s)
- Karen H Albritton
- Cook Children's Medical Center, Fort Worth, Texas;Department of Pediatrics, University of North Texas Health Science Center, Fort Worth, Texas; and
| | - Peter Coccia
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
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13
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Birch RJ, Morris EJA, Stark DP, Morgan S, Lewis IJ, West RM, Feltbower RG. Geographical Factors Affecting the Admission of Teenagers and Young Adults to Age-Specialist Inpatient Cancer Care in England. J Adolesc Young Adult Oncol 2014; 3:28-36. [PMID: 24669356 DOI: 10.1089/jayao.2013.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: Little is known about the factors that influence the place of inpatient care for teenage and young adult (TYA) cancer patients. Recent guidelines have recommended centralization of care for this group to a small number of specialized centers. This study aimed to investigate the influence of geography and travel times on the likelihood of admission to an age-specialist center in England during cancer treatment for patients aged 15-24 at the time of diagnosis. Methods: Data for 6788 patients aged 15-24, diagnosed between 2001 and 2006 and treated as an inpatient in England between 2001 and 2009, were obtained from the National Cancer Data Repository. Eight TYA age-specialist centers were identified in England during this time period; road travel times to these centers were calculated using ArcGIS Network Analyst. Factors thought to affect the likelihood of admission, such as diagnostic group, gender, and age at diagnosis were modeled using logistic regression. Results: Overall, 66.9% of patients never received inpatient treatment at a TYA age-specialist center during the course of their treatment. Increasing travel time significantly reduced the likelihood of admission to a TYA age-specialist center after adjustment for case mix factors. Conclusion: Many TYA patients received little or no inpatient treatment at a TYA age-specialist center during their treatment. The variation between diagnostic groups suggests that factors other than distance to the closest center are affecting the likelihood of admission and demonstrates the potential need to consider improvements to the structured referral practice for this unique group of patients.
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Affiliation(s)
- Rebecca J Birch
- Cancer Epidemiology Group, University of Leeds , Leeds, United Kingdom
| | - Eva J A Morris
- Cancer Epidemiology Group, University of Leeds , Leeds, United Kingdom
| | - Dan P Stark
- Medical Oncology, St. James's Institute of Oncology , Leeds, United Kingdom
| | - Sue Morgan
- Teenage Cancer Trust Unit, Leeds Teaching Hospitals NHS Trust , Leeds, United Kingdom
| | - Ian J Lewis
- Alder Hey Children's NHS Foundation Trust , Liverpool, United Kingdom
| | - Robert M West
- Leeds Institute of Health Sciences , University of Leeds , Leeds, United Kingdom
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14
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Birch RJ, Morris EJA, West RM, Stark DP, Lewis I, Morgan S, Feltbower RG. A cross-sectional survey of healthcare professionals to determine what they believe constitutes 'specialist' care for teenage and young adult patients with cancer. BMJ Open 2013; 3:bmjopen-2012-002346. [PMID: 23645913 PMCID: PMC3646178 DOI: 10.1136/bmjopen-2012-002346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the attitudes of UK healthcare professionals towards what they believe constitutes specialist care for teenage and young adult (TYA) patients with cancer, to determine which factors they considered to be the most important components of specialist TYA care, and whether opinion varied between clinical specialties and reflected the drivers for care improvements within National Health Service (NHS) policy. DESIGN AND METHODS The study utilised a cross-sectional survey, using Likert scales, to assess attitudes towards specialist care. Responses were grouped using model-based clustering methods implemented in LatentGold 4.5. SETTING Participants from 98 NHS trusts in the UK were invited to participate in the study. PARTICIPANTS 691 healthcare professionals involved in the management of TYA patients were approached; of these, 338 responded. RESULTS 338 healthcare professionals responded (51.9% of those invited). Responses were grouped into three clusters according to the pattern of responses to the questions. One cluster rated age-appropriate care above all else, the second rated both age and site-appropriate care highly while the third assigned more importance to site-specific care. Overall, the psychosocial and supportive aspects of care were rated highest while statements relating to factors known to be important (access to clinical trials, treatment at a high volume centre and specialist diagnostics) were not rated as highly as expected. CONCLUSIONS Attitudes varied widely between professionals treating TYA patients with cancer as to what constitutes key aspects of specialist care. Further work is needed to quantify the extent to which this influences practice.
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Affiliation(s)
- Rebecca J Birch
- Paediatric Epidemiology Group, University of Leeds, Leeds, UK
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15
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Sansom-Daly UM, Wakefield CE, Bryant RA, Butow P, Sawyer S, Patterson P, Anazodo A, Thompson K, Cohn RJ. Online group-based cognitive-behavioural therapy for adolescents and young adults after cancer treatment: a multicenter randomised controlled trial of Recapture Life-AYA. BMC Cancer 2012; 12:339. [PMID: 22862906 PMCID: PMC3503656 DOI: 10.1186/1471-2407-12-339] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cancer diagnosis is 2.9 times more likely to occur during the adolescent and young adult years than in younger children. This spike in incidence coincides with a life stage characterised by psychological vulnerability as young people strive to attain numerous, critical developmental milestones. The distress young people experience after cancer treatment seriously jeopardises their ability to move into well-functioning adulthood. METHODS/DESIGN This article presents the protocol of the Recapture Life study, a phase II three-arm randomised controlled trial designed to evaluate the feasibility and efficacy of a new intervention in reducing distress and improving quality of life for adolescent and young adult cancer survivors. The novel intervention, "ReCaPTure LiFe" will be compared to a both a wait-list, and a peer-support group control. Ninety young people aged 15-25 years who have completed cancer treatment in the past 1-6 months will be recruited from hospitals around Australia. Those randomised to receive Recapture Life will participate in six, weekly, 90-minute online group sessions led by a psychologist, involving peer-discussion around cognitive-behavioural coping skills (including: behavioural activation, thought challenging, communication and assertiveness skills training, problem-solving and goal-setting). Participants randomised to the peer-support group control will receive non-directive peer support delivered in an identical manner. Participants will complete psychosocial measures at baseline, post-intervention, and 12-months post-intervention. The primary outcome will be quality of life. Secondary outcomes will include depression, anxiety, stress, family functioning, coping, and cancer-related identity. DISCUSSION This article reviews the empirical rationale for using group-based, online cognitive-behavioural therapy in young people after cancer treatment. The potential challenges of delivering skills-based programs in an online modality are highlighted, and the role of both peer and caregiver support in enhancing the effectiveness of this skills-based intervention is also discussed. The innovative videoconferencing delivery method Recapture Life uses has the potential to address the geographic and psychological isolation of adolescents and young adults as they move toward cancer survivorship. It is expected that teaching AYAs coping skills as they resume their normal lives after cancer may have long-term implications for their quality of life. TRIAL REGISTRATION ACTRN12610000717055.
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Affiliation(s)
- Ursula M Sansom-Daly
- Centre for Children’s Cancer and Blood Disorders (CCC&BD), Level 1, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia
| | - Claire E Wakefield
- Centre for Children’s Cancer and Blood Disorders (CCC&BD), Level 1, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Phyllis Butow
- School of Psychology, Brennan MacCallum Building, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Susan Sawyer
- Centre for Adolescent Health, Royal Children’s Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | | | - Antoinette Anazodo
- Sydney Youth Cancer Service, Medical Professorial Unit, 1st Floor South Wing Edmund Blackett Building, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
| | - Kate Thompson
- OnTrac@PeterMac, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, Melbourne, VIC, 8006, Australia
| | - Richard J Cohn
- Centre for Children’s Cancer and Blood Disorders (CCC&BD), Level 1, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia
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GIBSON F, FERN L, WHELAN J, PEARCE S, LEWIS I, HOBIN D, TAYLOR R. A scoping exercise of favourable characteristics of professionals working in teenage and young adult cancer care: ‘thinking outside of the box’. Eur J Cancer Care (Engl) 2012; 21:330-9. [DOI: 10.1111/j.1365-2354.2011.01322.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ramphal R, D'Agostino N, Klassen A, McLeod M, De Pauw S, Gupta A. Practices and Resources Devoted to the Care of Adolescents and Young Adults with Cancer in Canada: A Survey of Pediatric and Adult Cancer Treatment Centers. J Adolesc Young Adult Oncol 2011; 1:140-4. [DOI: 10.1089/jayao.2011.0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Raveena Ramphal
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Norma D'Agostino
- Psychosocial Oncology and Palliative Care, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Anne Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Megan McLeod
- Community Cancer Programs Network, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Sonja De Pauw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Abha Gupta
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Taylor RM, Fern L, Whelan J, Pearce S, Grew T, Millington H, Ashton J, Brooman K, Starkey C, Gibson F. “Your Place or Mine?” Priorities for a Specialist Teenage and Young Adult (TYA) Cancer Unit: Disparity Between TYA and Professional Perceptions. J Adolesc Young Adult Oncol 2011; 1:145-51. [DOI: 10.1089/jayao.2011.0037] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachel M. Taylor
- Cancer Institute, University College London and Department of Children's Nursing, London South Bank University, London, United Kingdom
| | - Lorna Fern
- National Cancer Research Institute, Teenage and Young Adult Clinical Studies Group (NCRI TYA CSG), London, United Kingdom
| | - Jeremy Whelan
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Susie Pearce
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom Grew
- NCRI TYA CSG Core Consumer Group (CCG), London, United Kingdom
| | | | - James Ashton
- NCRI TYA CSG Core Consumer Group (CCG), London, United Kingdom
| | - Kate Brooman
- NCRI TYA CSG Core Consumer Group (CCG), London, United Kingdom
| | - Carol Starkey
- NCRI TYA CSG Core Consumer Group (CCG), London, United Kingdom
| | - Faith Gibson
- Great Ormond Street Hospital for Children NHS Trust and Department of Children's Nursing, London South Bank University, London, United Kingdom
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MARRIS S, MORGAN S, STARK D. ‘Listening to Patients’: what is the value of age-appropriate care to teenagers and young adults with cancer? Eur J Cancer Care (Engl) 2011; 20:145-51. [DOI: 10.1111/j.1365-2354.2010.01186.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Moxham L, Dwyer T, Happell B, Reid-Searl K, Kahl J, Morris J, Wheatland N. Recognising our role: improved confidence of general nurses providing care to young people with a mental illness in a rural paediatric unit. J Clin Nurs 2010; 19:1434-42. [DOI: 10.1111/j.1365-2702.2009.02993.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Today, long-term survival is achieved in more than 80% of children 1 to 10 years old with acute lymphoblastic leukemia (ALL). However, cure rates for adults and adolescents and young adults (AYA) with ALL remain relatively low, at only 40% to 50%. Age is a continuous prognostic variable in ALL, with no single age at which prognosis deteriorates markedly. Within childhood ALL populations, older children have shown inferior outcomes, whereas younger adults have shown superior outcomes among adult ALL patients. The type of treatment (pediatric-based versus adult-based) for AYA has recently been a matter of debate. In this article the biology and treatment of ALL in AYA is reviewed.
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Affiliation(s)
- Josep-Maria Ribera
- Clinical Hematology Department, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autonoma de Barcelona, C/Canyet s/n, 08916 Badalona, Spain.
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23
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Pearce S. Policy and practice in teenage and young adult cancer care in England: Looking to the future. Eur J Oncol Nurs 2009; 13:149-53. [DOI: 10.1016/j.ejon.2009.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/28/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Dini G, Banov L, Dini S; EBMT Paediatric Diseases Working Party. Where should adolescents with ALL be treated? Bone Marrow Transplant 2008; 42 Suppl 2:S35-9. [PMID: 18978742 DOI: 10.1038/bmt.2008.281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Currently, 50% of adolescents with ALL are treated by adult teams and 50% by paediatric teams (following either adult or paediatric protocols). The aim of this paper is to review the results obtained with first-line chemotherapy and with haematopoietic SCT (HSCT) in adolescents with ALL. Disease biology and host factors are responsible for the differences observed between adolescents and other age categories. The outcome of adolescents with ALL after first-line chemotherapy is poorer as compared with children, although better as compared with adults. Recent studies have shown that adolescents who were enrolled in paediatric trials achieved better results than those who were enrolled in adult trials. This is most likely because of several differences, including protocol design, dose intensity and use of HSCTs, as well as better compliance to treatment and better supportive care. Disparities in the attitude towards treatment between paediatric and adult wards might also contribute to the better outcome that is observed in paediatric institutions. Indications for HSCT in children with ALL are well defined by international protocols. Only very high-risk paediatric patients are eligible for HSCT in CR1, whereas in adult trials, allogeneic or autologous HSCT are frequently offered, even to standard-risk patients in CR1. The outcome of adolescents given HSCT is poorer than in children, though better than in adults. Improving both psychosocial support during therapy and physical exercise habits represent further challenges for teams involved in the treatment of adolescents. Cooperation between paediatric and adult haematologists would surely improve the ability to recruit as many patients as possible and would promote progress in the research on adolescents. In conclusion, redefining age limits according to risk-based strategies, as well as encouraging multi-centre cooperation, should be taken into consideration to improve the outcome of this age category. Adolescents should be referred to research treatment teams that have experience in the management of paediatric ALL and they should be enrolled in international cooperative studies.
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Abstract
Cancer in adolescents is uncommon and when it occurs raises a number of unique challenges for both the patient and their families. Adolescence is a period of time of significant physical and emotional changes and a diagnosis of cancer during this time has a major impact on their psychological and physical development. In this review we will look at the psychosocial issues facing adolescents who have cancer. We will address adolescent development, issues related to informed consent and assent, initial responses to the diagnosis of cancer, quality of life and the experience of the adolescent with cancer, psychological adjustment, support systems, body image issues, sexuality, education, hope, and treatment compliance.
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Affiliation(s)
- Annah N Abrams
- Department of Child Psychiatry and Pediatric Hematology-Oncology, Massachusetts General Hospital, Boston, MA 02114, United States.
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Abstract
OBJECTIVES There is little evidence to support the effectiveness of adolescent inpatient wards. These analyses test the hypotheses that nursing young people in adolescent wards improves aspects of quality of care and patient satisfaction compared with child or adult wards. PATIENTS AND METHODS Secondary analyses of the national English Young Patient Survey 2004 were weighted to take account of variations in hospital size and response rate. Participants included 8855 subjects aged 12 to 17 years. Ward types (adolescent, child, and adult) were compared. Patient-reported quality-of-care indicators included rating by young people of overall care, respect, safety, confidentiality, communication, team-working, noise, and leisure facilities. Logistic regression models were adjusted for gender, disability, and previous hospital admissions. RESULTS Ten percent of 12- to 14-year-olds and 18% of 15- to 17-year-olds were nursed in an adolescent ward, 0.4% of 12- to 15-year-olds and 16% of 15- to 17-year-olds in an adult ward, with the remainder in a child ward. Compared with being in an adolescent ward, 15- to 17-year-olds were less likely to report excellent overall care in an adult ward and less likely to report feeling secure, having confidentiality maintained, feeling treated with respect, confidence in staff, appropriate information transmission, appropriate involvement in own care, and appropriate leisure facilities. Compared with being in an adolescent ward, 12- to 14-year-olds were less likely to report excellent overall care in a child ward and less likely to report feeling involved in their own care. CONCLUSIONS Dedicated adolescent inpatient wards improve aspects of quality of care for young people compared with child or adult wards, particularly for older adolescents. These data support the continued development of adolescent wards in larger general hospitals and children's hospitals.
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Affiliation(s)
- Russell M Viner
- General and Adolescent Paediatrics Unit, Institute of Child Health, University College London, London, United Kingdom.
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Ramanujachar R, Richards S, Hann I, Goldstone A, Mitchell C, Vora A, Rowe J, Webb D. Adolescents with acute lymphoblastic leukaemia: outcome on UK national paediatric (ALL97) and adult (UKALLXII/E2993) trials. Pediatr Blood Cancer 2007; 48:254-61. [PMID: 16421910 DOI: 10.1002/pbc.20749] [Citation(s) in RCA: 209] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adolescents with acute lymphoblastic leukaemia (ALL) have languished in the shadow of success of the outcome of therapy in childhood ALL. Their treatment has always been incorporated into either paediatric or adult clinical trials depending on the mode of referral and hence there is a need to address an age and risk specific strategy for improving the outcome of this neglected group of patients. This article has summarised the recent and updated retrospective comparative analysis of adolescents treated on the Medical Research Council (MRC) trials. This analysis adds further emphasis to the treatment approach and the merits and limitations of treatment of adolescents on paediatric and adult trials. METHODS A retrospective comparative analysis of adolescents aged 15-17 years, treated on either MRC ALL97/revised 99 (n = 61), a randomised paediatric trial or UKALLXII/E2993 (n = 67), an adult trial, between 1997 and 2002 was undertaken. RESULT Results suggest a trend towards a superior outcome on paediatric trials. The 5-year EFS on ALL97 was 65% (95% CI = 52-78%) and on UKALLXII/E2993 was 49% (95% CI = 37-61%; P = 0.01). Multivariate analysis allowing for age and Ph status, diminished the EFS difference, but confirmed a reduced rate of death in remission in patients managed on the paediatric protocol. CONCLUSIONS Despite limitations in the methodology, comparative studies including our MRC study suggest a consistent advantage for adolescents managed intensively on paediatric trials. Redefining age limits with risk-based strategy and multi-centre collaboration should be considered to improve the survival of young adults.
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Affiliation(s)
- Ramya Ramanujachar
- Department of Molecular Haematology, Institute of Child Health, London, United Kingdom
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Desandes E, Lacour B, Sommelet D, White-Koning M, Velten M, Tretarre B, Marr A, Maarouf N, Guizard AV, Delafosse P, Danzon A, Cotte C, Brugieres L. Cancer adolescent pathway in France between 1988 and 1997. Eur J Oncol Nurs 2007; 11:74-81. [PMID: 16814605 DOI: 10.1016/j.ejon.2006.04.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 02/13/2006] [Accepted: 04/02/2006] [Indexed: 11/15/2022]
Abstract
We report an adolescent cancer pathway from referral, through diagnosis and treatment, to follow-up in France. All cases of cancer among 15-19 years, diagnosed from 1988 to 1997, recorded by nine French population-based cancer registries (10% of French population) were included. The management of adolescent cancer by paediatricians was rare. An adolescents' pathway through cancer care can be summarized as first visit to general practitioner, referral to adult oncologist for haematological malignancy and medical or surgical specialists for solid tumours, treatment in adult unit, and follow-up by adult oncologist, adult medical or surgical specialist, or general practitioner. Only 9% of the 15-19 years are entered into a clinical trial (respectively 6% and 3% into adult and paediatric clinical trial). The inclusion rate changes according to the diagnosis, higher for acute lymphoblastic leukaemia (39%), non-Hodgkin's lymphomas (NHL) (27%), and acute non-lymphoblastic leukaemia (20%). Only 4% of adolescent cancers were managed on shared adult/paediatric departments, especially for soft-tissue sarcomas (14.9%), malignant bone tumours (13.4), central nervous system tumours (6.2%), and NHL (4.4%). Whatever the reasons for lack of participation in clinical trials, an ideal model requiring communication and cooperation between all adult and paediatric specialists involved in adolescent cancer treatment should reduce the large gap in access to cooperative groups.
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Affiliation(s)
- Emmanuel Desandes
- French National Registry of Childhood Solid Tumours, Vandoeuvre-lès-Nancy, France.
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Ramanujachar R, Richards S, Hann I, Webb D. Adolescents with acute lymphoblastic leukaemia: emerging from the shadow of paediatric and adult treatment protocols. Pediatr Blood Cancer 2006; 47:748-56. [PMID: 16470520 DOI: 10.1002/pbc.20776] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adolescents and young adults (AYA) with acute lymphoblastic leukaemia (ALL) constitute a distinct population from children and older adults. Based on patterns of referral, they may be treated by either paediatric or adult oncologists. As a group, AYA with ALL have a worse survival and event-free survival (EFS) compared to that achieved by younger children. A systematic review of all published clinical trials, which provide data on treatment and outcome of adolescents with ALL, has been summarised in an effort to determine whether they should be treated on paediatric or adult type protocols. Adolescents appear to have a consistent survival advantage when treated on paediatric regimens.
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Affiliation(s)
- Ramya Ramanujachar
- Department of Molecular Haematology, Institute of Child Health, London, UK
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Affiliation(s)
- L Brugières
- Département de pédiatrie, institut Gustave-Roussy, Villejuif, France
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