Camp programs for children with cancer and their families: review of research progress over the past decade

Pumilio RNA binding family member 1 deficiency activates anti-tumor immunity in hepatocellular carcinoma via restraining M2 macrophage polarization

Pumilio RNA-binding family member 1 (PUM1) has been implicated in both the progression of colorectal cancer and the regulation of inflammation. The role of PUM1 in the polarization of tumor-associated macrophages (TAMs) into the M2 phenotype has not yet been reported in hepatocellular carcinoma. Using the PUM1-knockout mice model, flow cytometry, and IHC, we validated the role of PUM1 in hepatocellular carcinoma (HCC) TAMs. One-way analysis of variance (ANOVA) or student's t-tests was used to compare the experimental groups. We found that PUM1 inhibited anti-tumor immunity in HCC through TAM-mediated inhibition of CD8+ T cells. We also showed that PUM1 promotes the transformation of TAMs into pro-tumorigenic M2-like phenotypes by activating cAMP signaling pathway. This study emphasized the potential of PUM1 as a target for immunotherapy in HCC through TAMs. The present study revealed the molecular mechanism underlying the pro-tumor role of PUM1 in HCC.

Factors that influence families' decision to send their children to a week-long pediatric oncology camp and thoughts about attending camp

PURPOSE

We sought to understand: families' experience of an overnight pediatric oncology camp open to children with cancer and their siblings aged seven to seventeen (Camp Delight); the considerations that factor into families' decision to attend camp for the first time; and what motivates them to reattend.

METHOD

Eleven semi-structured interviews were conducted with families who attended Camp Delight during or before August 2020. Thematic analysis was performed using a framework developed by four coders and MaxQDA software.

RESULT

Six overarching themes were compiled: precipitating experiences, barriers to attending camp, facilitating factors, benefits of camp, pro-return factors, and activities to improve transitioning to camp and reduce uncertainty.

CONCLUSION

Child and parent hesitancy, travel cost, and distance to camp represent barriers to attendance. Organizers may mitigate these barriers by partnering with trusted health professionals, communicating safeness and benefits of camps, including siblings, implementing strategies for reducing uncertainty, and increasing accessibility.

What helps distressed Australian adolescents impacted by cancer? Mechanisms of improvement of the PEER program

PEER is a four-day residential program for adolescents impacted by their own or a relative's cancer, with both psychosocial (acceptance and commitment therapy, self-compassion) and recreational components. This study aimed to determine whether previously observed improvements in quality of life amongst highly distressed participants were mediated by improvements in processes targeted by psychotherapeutic elements of the program (psychological flexibility, mindfulness, self-compassion, peer support, distress). Adolescents attending PEER completed surveys assessing the quality of life and proposed mediator variables at pre-program, post-program and two-month follow-up. Adolescents experiencing high/very high levels of baseline distress (n = 52; 5 patients/survivors, 31 siblings/offspring, 13 bereaved siblings/offspring) were previously identified as experiencing clinically significant improvements in psychosocial well-being; here, mediation analyses explored whether these improvements were associated with improvements in process variables. Findings evidenced improvements in quality of life amongst distressed PEER participants, mediated by increases in psychological flexibility and self-compassion, and reductions in distress. Peer support and mindfulness were not significant mediators. Together, this suggests that the psychosocial benefits of PEER observed for highly distressed adolescents are linked to the specific therapeutic approaches used in the program, rather than being non-specific effects of peer connection or recreation. Findings from this evaluation provide further evidence for the efficacy and mechanisms of the effect of PEER for supporting distressed adolescents impacted by cancer. The study also demonstrates the viability and utility of the therapeutic approaches (acceptance and commitment therapy, self-compassion) used, showing that they have psychosocial benefits for this population.

The effects of Swiss summer camp on the development of socio-emotional abilities in children

This quasi-experimental research explores the relationship between participation in two-week summer camps and changes in children's altruism and self-esteem. Data were collected from 256 children aged 6 to 16 years. A self-reported altruism scale, a self-evaluation questionnaire and a temperament measure (EAS) were administered on two occasions either two weeks apart during the summer holidays or in class before and after the autumn holidays. The responses of 145 children attending summer camps were compared with those of 111 pupils. A significant increase in the altruism score was found between the pre-test and post-test in the camp condition, but no change in the children's self-esteem was found with the entire sample. Exploratory analyses suggest variables that may be associated with more favourable participation in summer camps; certain dimensions of temperament are among them, as well as factors related to the camps themselves. Differences in the increase of altruism and self-esteem scores in summer camp were observed according to the identified child profiles. The limitations of this work are highlighted before proposing perspectives for future research.

The role of burn camp in the recovery of young people from burn injury: A qualitative study using long-term follow-up interviews with parents and participants

BACKGROUND

Children and adolescents recovering from burn injury are at heightened risk of psychosocial problems. An integrative form of psychosocial intervention is burn camp. However, evidence about burn camp effectiveness is equivocal.

OBJECTIVES

This study examined the role of therapeutic camp experiences in the recovery journeys of children and adolescents who had experienced burn injury and been treated in a tertiary pediatric hospital in Brisbane, Australia.

METHODS

Retrospective semi-structured interviews were conducted with youths and parents. Inductive reflexive thematic analysis was used with pooled interview data.

RESULTS

The participants were eight youths who attended at least one burns camp (between 2009 and 2019) and 15 parents of youth campers. An overwhelming majority (96%) reported a positive experience of camp, that they would return, and that they recommended the camp to other youth with burns. The four strengths of the camp experience were fun, adventurous activities; social relatedness (friendships, socializing); camp setting and experience; and acceptance. The four impacts of the camp on youth campers were normalizing ("I'm not the only one", shared experience); social support (making new friendships, social confidence, mentoring others); psychological recovery (happier, mentally stronger, more resilient, independence building); and confidence (increased self-confidence, increased social confidence, leadership development).

CONCLUSIONS

Although this is the first known research about burn camp in Australia, the findings are similar to a handful of other qualitative studies about burn camp experiences and impacts. Recommendations include future research on aspects of camp experiences that contribute to targeted outcomes, the role of staff and previous camp participants as mentors, and comparisons with other psychosocial interventions for youth burn survivors.

Neurodevelopmental and psychosocial interventions for individuals with CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative

In 2018, the Neurodevelopmental and Psychosocial Interventions Working Group of the Cardiac Neurodevelopmental Outcome Collaborative convened through support from an R13 grant from the National Heart, Lung, and Blood Institute to survey the state of neurodevelopmental and psychosocial intervention research in CHD and to propose a slate of critical questions and investigations required to improve outcomes for this growing population of survivors and their families. Prior research, although limited, suggests that individualised developmental care interventions delivered early in life are beneficial for improving a range of outcomes including feeding, motor and cognitive development, and physiological regulation. Interventions to address self-regulatory, cognitive, and social-emotional challenges have shown promise in other medical populations, yet their applicability and effectiveness for use in individuals with CHD have not been examined. To move this field of research forward, we must strive to better understand the impact of neurodevelopmental and psychosocial intervention within the CHD population including adapting existing interventions for individuals with CHD. We must examine the ways in which dedicated cardiac neurodevelopmental follow-up programmes bolster resilience and support children and families through the myriad transitions inherent to the experience of living with CHD. And, we must ensure that interventions are person-/family-centred, inclusive of individuals from diverse cultural backgrounds as well as those with genetic/medical comorbidities, and proactive in their efforts to include individuals who are at highest risk but who may be traditionally less likely to participate in intervention trials.

Camps for Children with Cancer and Their Families: A Systematic Review of Psychosocial and Physical Impacts

OBJECTIVE

Camps for children with cancer and their families aim to promote positive psychosocial and physical outcomes for attendees. However, evidence for this is inconsistent, and previous reviews have not delineated between camps for children (patient/survivors and siblings) and family camps (including parents/guardians). Such understanding is necessary to understand the evidence-based benefits of each type of camp. Our systematic review summarizes the findings and limitations of the recent literature for children's camps and family camps.

METHODS

We searched MEDLINE/PubMed, PsycINFO, Social Work Abstracts, and Google Scholar for relevant articles published between 2013 and 2018.

RESULTS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we included 19 articles (from 15 studies) in the review. Evidence for the impact of camps was mixed. All articles reported positive outcomes, yet 3 quantitative articles also reported nonsignificant changes. Camps for children (representing 2151 children with cancer/survivors) appeared to facilitate social skills, self-esteem, and physical activity. Family camps (representing 96 families) may provide families the opportunity to reconnect. Both types of camp provide attendees with social support and fun/respite. In 2 qualitative articles, some parents attending family camps reported tension between families of children on treatment and bereaved families. The literature is limited by small sample sizes and the lack of multisite, longitudinal, and controlled study designs.

CONCLUSION

The recent literature provides evidence for some positive, short-term psychosocial and physical outcomes of camps. Future research should use rigorous quasiexperimental designs and should assess the long-term impact of camp attendance.

Psychosocial interventions for siblings of children with cancer: A mixed methods systematic review

OBJECTIVE

This review systematically (1) describes the characteristics of psychosocial interventions for siblings of children with cancer (SCC); (2) assesses the effect of the psychosocial interventions on SCCs' outcomes, and (3) describes SCCs' experiences and perceptions of these interventions.

METHODS

Seven databases were systematically searched for relevant literature. We included both quantitative and qualitative studies of psychological interventions designed to improve the adjustment of SCCs.

RESULTS

Our database searches yielded 19 publications. We found a range of psychosocial interventions being used among SCCs, with group interventions being the most common. The primary outcomes focused on the SCCs' depression, anxiety, and quality of life. Quantitative studies provided insufficient evidence to draw definitive conclusions about the interventions' effects, whereas the qualitative studies indicated that SCCs can derive benefits from these interventions, including an enhanced sense of belonging and bonding, improved family relationships, increased self-awareness and confidence, increased cancer knowledge, and decreased somatic symptoms.

CONCLUSIONS

Although a growing number of psychosocial interventions have been developed to improve the adjustment of SCCs, research evidence of the effects of these interventions on SCCs' adjustment remains limited. Future research needs to rigorously evaluate the effects of these interventions.

A scoping review to map the concept, content, and outcome of wilderness programs for childhood cancer survivors

OBJECTIVES

Systematic mapping of the concept, content, and outcome of wilderness programs for childhood cancer survivors.

DESIGN

Scoping review.

SEARCH STRATEGY

Searches were performed in 13 databases and the grey literature. Included studies describe participation of childhood cancer survivors in wilderness programs where the role of nature had a contextual and therapeutic premise. At least two authors independently performed screening, data extraction and analysis.

RESULTS

Database searches yielded 1848 articles, of which 15 met the inclusion criteria. The majority of programs (73%) employed adventure therapy. Five activity categories were identified as components of wilderness programs: challenge/risk, free time/leisure, experiential learning, physical activity and psychotherapeutic activities. A majority of the participating childhood cancer survivors were female, white, aged 8-40 years, with a wide range of cancer diagnoses. Reported outcomes included increased social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity. Key gaps identified included the absence of randomized controlled trials (RCTs), lack of studies on long-term effects, lack of information on the multicultural aspects of programs, and missing information on engagement in nature activities after the program ended.

CONCLUSIONS

This scoping review guides childhood cancer survivors, their families, practitioners, clinicians and researchers in the development and optimization of wilderness programs for childhood cancer survivors. In addition, it informs the utilization of these programs, and identifies gaps in the evidence base of wilderness programs. It is recommended that future study reporting on wilderness programs include more detail and explicitly address the role of nature in the program. Performing RCTs on wilderness programs is challenging, as they occur in real-life contexts in which participants cannot be blinded. Creative solutions in the design of pragmatic trials and mixed method studies are thus needed for further investigation of the effectiveness and safety of wilderness programs in childhood cancer survivors.

The core features and outcomes of a specialised camp programme for children with life-limiting conditions and their families: A qualitative multi-perspective approach

Previous research has reported that the families of children with enduring and life-limiting health conditions are at risk of negative psychosocial effects. Adjunct to medical interventions, specialist camp programmes have been developed to promote familial adjustment. However, limited research has been carried out in this area. The aim of this study was to describe the core features and outcomes of a specialised camp programme for children with life-limiting conditions (LLC) and their family. Semi-structured interviews were conducted with four professionals, three volunteers involved in facilitating the programme and two mothers representing families that attended the programme. Multiple perspectives were sought to gain a detailed understanding of the programme and outcomes. Data were analysed through an inductive thematic approach. There was considerable overlap among participant groups on the core features and outcomes of the programme. Thematically, core features are described in terms of familial togetherness, peer interaction, safety and positive experiences. Noted outcomes include lasting memories, continued peer relations for parents and siblings and enhancement of relationships between family members and professionals. Findings suggest that specialised camp programmes may provide families of children with LLC with positive experiences that support adjustment, although further research is required.

The role of Connected Health technologies in supporting families affected by paediatric cancer: A systematic review

OBJECTIVES

Families impacted by paediatric cancer are met with logistical, financial and psychological impacts, with severe acute respiratory syndrome coronavirus two creating additional barriers and stressors for these families. Connected Health (CH) may facilitate cancer care. The objective of the present study was to systematically review CH for families/informal caregivers affected by paediatric cancer.

METHODS

Using search terms relating to: (1) paediatric cancer, (2) family/caregivers and (3) CH, the databases of PsycINFO, Pubmed, EMBASE and Web of Science were searched. Inclusion criteria included an evaluation of CH technologies for supportive care for families/caregivers affected by paediatric cancer at any stage of treatment or survivorship.

RESULTS

Sixteen studies met inclusion criteria. CH was primarily web-based (n = 6), however smartphone applications (n = 5), telehealth (n = 2) and online groups (n = 3) were utilised. Intervention areas included psycho-social (n = 6), health and information provision (n = 8) and palliative care (n = 2).

CONCLUSIONS

While limited studies have evaluated the impact of CH on families living with paediatric cancer, emerging evidence suggests potential benefits. More evidenced-based interventions are required.

Perception of Inpatient Oncologic Rehabilitation in Children, Adolescents and Young Adults Diagnosed with Cancer in Switzerland

BACKGROUND

Inpatient rehabilitation improves physical and psychosocial performance in childhood cancer patients and their families. Two kinds of inpatient rehabilitation are available in specialized institutions in Germany: family-oriented rehabilitation or peer group-oriented rehabilitation for adolescents and young adults (AYA). Our study aimed to find out what Swiss childhood and AYA cancer patients and their families thought about the rehabilitation programs in which they had participated.

PATIENTS AND METHODS

We conducted a questionnaire-based, cross-sectional study of Swiss childhood and AYA cancer patients and their families whose inpatient rehabilitation stays were scheduled to take place in Germany between May 2012 and March 2019. We analyzed the data descriptively and present our findings in accordance with the STROBE statement.

RESULTS

Of the 57 eligible families contacted, 38 (67%) responded. Most rated the rehabilitation stay as very good (68%) or good (26%). Nearly all participants emphasized that these programs should be available to all affected patients and their families. Most (80%) thought the program gave them enough valuable information to enable them to cope with daily life after the stay ended. Only one fifth (19%) of the rehabilitation stays were fully funded by the health or disability insurance.

CONCLUSION

Participants expressed an overwhelmingly positive opinion about the rehabilitation programs they attended. We are convinced that childhood and AYA cancer patients and their families in Switzerland benefit from these programs and encourage insurances to cover the costs.

Adventure therapy for child, adolescent, and young adult cancer patients: a systematic review

PURPOSE

This systematic review aimed to examine the evidence on adventure therapy (AT) intervention for child, adolescent, and young adult (AYA) cancer patients in order to inform the design of future research and clinical practice.

METHODS

This review included studies that tested the AT intervention among child and AYA cancer patients. Nine electronic databases (CINAHL, Cochrane Central Register of Controlled Trials, EMBase, Medline via EbscoHost, OpenGrey, PsycInfo, Web of Science, Scopus, and PubMed) were searched for English-language published studies using a quasi-experimental design, one-group pre-test-post-test experimental study design, or randomized controlled trial (RCT) from 1981 to May 2020. The methodological quality of the included studies was evaluated using JBI Critical Appraisal Checklists for RCTs and for Quasi-Experimental Studies by two researchers independently. A narrative synthesis of intervention characteristics and related health-related outcomes was performed.

RESULTS

Eight papers from seven studies were included in the review, namely four RCTs, two quasi-experimental study papers, and two one-group pre-test-post-test experimental study papers. Studies varied in the components and duration of AT. Medium to high methodological quality of included studies was noted in all study designs. Results showed the positive effects of AT on the physical activity, fatigue, psychological distress, and quality of life of child and AYA cancer patients.

CONCLUSION

AT is a promising intervention that may improve a number of health-related outcomes in child and AYA cancer patients. Evidence-based AT interventions should be developed and incorporated as part of supportive care for the target population.

Quantifying the psychosocial impact of a weekend retreat on adolescent and young adult (AYA) oncology patients

OBJECTIVE

This study aimed to determine if AYA oncology patients experienced a quantifiable improvement in psychosocial outcomes after attending a weekend retreat with their peers.

METHODS

AYA oncology patients attended a weekend retreat. They completed the Functional Assessment of Cancer Therapy - General (FACT-G) before, 1 month after, and 6 months after the weekend retreat. Controls were age-matched oncology patients who did not attend the retreat.

FINDINGS

Retreat participants' scores did not significantly change over time; however, retreat participants' scores at 1-month follow-up were significantly higher than control group scores.

CONCLUSIONS

AYA oncology patients may experience transient improvement in psychological well-being after attending a retreat, but benefits may not be durable. Work remains needed to examine the impact of retreat attendance on specific aspects of psychosocial well-being. Implications for psychosocial oncology: Work is needed to decrease perceived attendance barriers for AYA oncology patients who have a low quality of life. Future retreat planners may consider modifying retreat activities and consider alternative retreat locations that appeal to campers with limited mobility, chronic pain, and/or other quality of life limitations. Additional study is needed to determine whether brief overnight or weekend retreats can be as effective as week-long camps in enhancing oncology patients' quality of life. Future researchers should compare changes in weekend retreat attendees' quality of life to changes in quality of life for a control group (e.g., via a waitlist control study design).

Recommendations for medical care in the pediatric oncology camp setting: Consensus statements based on Delphi methodology

For many children with cancer, participation in oncology camp programs is an important component of healing that offers opportunities for fun and can have substantial impacts on social and physical well-being. Optimal medical care and infectious screening for children attending oncology camp is critical to maximize safety and opportunities for participation. This paper describes recommendations for a series of common medical issues unique to the care of children with cancer in the camp setting generated by a modified Delphi consensus approach.

Podendo ser si-mesmo: experiências de adolescentes com doenças crônicas de pele em acampamento

Resumo Objetivo compreender as experiências de adolescentes com doenças crônicas de pele que participaram de acampamento. Método estudo fenomenológico, com seis adolescentes com diagnóstico de doença crônica de pele, participantes de acampamento no Brasil. Coleta de dados: foram realizadas entrevistas fenomenológicas, no período de julho de 2015 a janeiro de 2016. Resultados três categorias temáticas emergiram e possibilitaram a compreensão do fenômeno. Participar do acampamento acarreta mudança na vida dos adolescentes e em seus modos-de-ser no mundo cotidiano. Impulsiona-os a refletir sobre o estigma já vivenciado anteriormente e as novas experiências, após participarem do acampamento, os auxilia no enfrentamento dos desafios da própria vida de maneira mais otimista. Conclusão Para os adolescentes, a experiência de participar do acampamento é transformadora, devido à possibilidade do encontro com pares e de vivenciar um ambiente livre de preconceito, permitindo ao adolescente ser si-mesmo. Implicações para prática Os acampamentos promovem interação entre pares, sendo estratégias acessíveis para profissionais de saúde, especialmente aos enfermeiros. Intervenções que, de fato, promovam assistência integral à saúde de crianças e adolescentes com condições crônicas de saúde e seus familiares, além da articulação entre serviços de complexidades distintas e seus profissionais de saúde, podem garantir o acesso ao cuidado de qualidade.

Nurse-Patient Connectedness and Nurses' Professional Quality of Life: Experiences of Volunteering at a Pediatric Oncology Camp

Objective: Pediatric oncology nurses can experience burnout, vicarious traumatization, and compassion fatigue related to the unique stressors of their profession. Opportunities to enhance nurses' professional commitment and nurse-patient connectedness may mitigate these stressors. This study explored the impact of volunteering at a local oncology camp on pediatric oncology nurses' professional quality of life and connectedness with their oncology patients. Method and Sample: Pediatric oncology nurses from a single institution were invited to participate in this mixed methods study. Participants completed a survey assessing professional quality of life, professional commitment, and patient connectedness. Nurses who had oncology camp volunteer experience were invited to participate in a qualitative interview. Results: Compared with noncamp nurses (n = 23), camp nurses (n = 25) had increased odds of a low burnout score (odds ratio = 6.74, 95% confidence interval [1.10, 41.43], p = .039) and increased odds of a high compassion satisfaction score (odds ratio = 4.69, 95% confidence interval [1.14, 19.32], p = .033). Qualitative interviews supported the impact of volunteering at camp on nurses' personal and professional perspective, nursing practice, and delivery of person-centered care. Conclusion: Volunteering at a pediatric oncology camp provided nurses the opportunity to engage with patients, share experiences, and view patients as individuals while still maintaining professional boundaries. Nurses who volunteer at camp described a perspective moving beyond patient-centered to person-centered care, and for some pediatric oncology nurses, camp volunteering may be a novel way to mitigate burnout and an important tool to enhance resiliency.

When the Future is Not Bright: Social and Political Stakes in Discussing Childhood Cancer in Romanian Media

In contemporary societies’ perception of children, death plays an incredibly insignificant role. This role goes from being ornamental, a weak reminder that our civilisation has overcome the times of children’s high mortality rates, to being some other society’s concern. Despite both medical improvements and cultural constructions of the child as an immanent and social transcendence, children can and do die. Although an increasing number of recent studies disclose and legitimise children’s preoccupation with death and dying in the context of a popular culture fascinated with death, studies interested in the representations of death and dying in children are rather scant. In this article, we investigate the social and political stakes in discussing children’s cancer in today’s Romanian media, aiming to make visible how the illustrations of the connections between children, death and illness are never ethically neutral. We begin with the observation that, during recent years, there has been a growing media focus on childhood cancer in Romania. Adopting a qualitative approach and resorting to comparative analysis, we analyse what lies beneath the intentions of criticising troublesome socio-political or medical realities of childhood cancer, revealing the mechanisms through which childhood cancer is transformed into a social illness and the cultural implications for the acceptance of death as an inherent part of life both for children and the population as a whole.

Program Evaluation of Camp V.I.P: Promoting Self-confidence and Independence for Patients with Spina Bifida

PURPOSE

Camp V.I·P (Victory, Independence, Possibilities) was established by the Spina Bifida Association of Alabama in 2012. The goal is to provide children with spina bifida (SB) and their families a traditional-style summer camp focusing on self-empowerment and fostering independence in medical self-management.

DESIGN AND METHODS

Part 1 of this study describes Camp V.I·P. structure. Part 2 describes an online survey to caregivers of campers gauging camp effectiveness and value and evaluating perceptions of confidence/independence and family connections. Camper characteristics were compared to the overall SB clinic population.

RESULTS

63 children with SB, 81 siblings, and over 100 caregivers have attended camp. Campers are similar to the overall clinic population in race, gender, and ambulation status. At camp, there are significantly more children with myelomeningocele (versus other spinal dysraphism) and lumbar functional level (versus thoracic). Survey results show that confidence grew in 93% of campers, and 86% gained greater independence. Parents stated that they created lifelong friendships. The majority of caregivers (91%) indicated "certainty" that they would attend camp again.

CONCLUSION

Camp V.I·P is a family-centered environment that emphasizes respite, nurture, and the continuum between family and clinic. Our research shows that camp can be a useful tool to aid in independence, confidence, and social adaption.

PRACTICE IMPLICATIONS

Camp has become an integral part of our comprehensive care of children with SB and has been shown to reinforce what is taught through the clinic by creating trust between the care team and campers.

"A place to call our own": The impact of camp experiences on the psychosocial wellbeing of children and youth affected by cancer - A narrative review

BACKGROUND

Although childhood cancer mortality rates are decreasing, intensive treatment modalities and missed school days may leave childhood cancer patients psychologically and socially vulnerable. Children with cancer often have increased anxiety, lower levels of self-esteem, and higher rates of depression, all of which may impair their psychosocial wellbeing. Specialized camps for children with cancer are becoming increasingly popular, as they provide a stress-free, outdoor environment in which children are able to interact with individuals similar to themselves, while experiencing the joys of a "normal childhood."

OBJECTIVE

The aim of this review was to explore how camp participation impacts the psychosocial wellbeing of childhood cancer patients and survivors.

METHODS

Six databases (MEDLINE, PsychINFO, EMBASE, CINHAL, Sociological Abstracts, Social Sciences Citation Index) were systematically searched for English literature published between 2007 and 2018. The search generated 1707 titles, and after being evaluated for relevance, 18 articles met the inclusion criteria. A thematic analysis was conducted.

RESULTS

A variety of camp programs and methodologies were employed among the studies. Camp participation led to improved social health, followed by enhanced constructions of the self, quality of life, sense of normalcy, and attitude.

CONCLUSION

This review demonstrates the potential ability of camp to buffer psychosocial losses for children affected by cancer. Addressing limitations, such as the lack of child-centered methodologies employed in camp settings, may not only help to guide future research on therapeutic recreation experiences for children with cancer, but also expand the evidence base for children living with other chronic illnesses and disabilities.

Tough decisions in medical specialty camps: Relationships between camp dosage, outcomes, and camper attendance

RATIONALE

Medical specialty camps play a significant role in the lives of the youth they serve. These camps have been found to improve self-determination in campers, to develop camper skills in managing a disability or coping with a diagnosis, and to provide campers with respite/escape from the challenges associated with their disability or diagnosis. Youth attending medical specialty camps are often funded through full or partial scholarships, mitigating a significant constraint to their participation. These resources are limited, leading camp administrators charged with allocating funding to make challenging decisions in determining which campers would most benefit from camp participation.

OBJECTIVE

This study examines a factor often linked to the escalating achievement of outcomes, repeated camp attendance, in 217 youth (ages 10-16) attending a one-week residential summer "Type 1 diabetes" camp. Specifically, two research questions were examined using a structural equation model (SEM): (1) what effect does repeat camp attendance (returning for multiple years) have on targeted outcome achievement, and (2) how does camper age moderate the relationship between repeated camp attendance and outcomes?

RESULTS

The study results indicate across the 10-outcomes tested in the study (e.g., relatedness, autonomy, competence), repeat attendance had no statistically meaningful effect (p ≤ .05) on outcome scores, nor did camper age moderate the strength of relationship between attendance and outcomes.

CONCLUSION

The lack of relationship between attendance and outcomes supports prior meta-analyses suggesting the lack of value of repeated attendance, as does the non-significant moderational effect. The results of this study may illustrate to program providers and funders that no discernible benefit (in terms of targeted and measured outcomes in the current study) is due to repeat attendance, which can inform resource allocation and camper recruitment decisions.

Psychosocial interventions for rehabilitation and reintegration into daily life of pediatric cancer survivors and their families: A systematic review

Background

The survival rate of childhood cancer patients increased over the past decades. However, even after successful treatment the transition back to normalcy is often a major challenge for the whole family. Therefore, this study aims to provide an overview of psychosocial interventions for childhood cancer survivors and their families in the first years after the end of cancer treatment.

Methods

We conducted a systematic review following the PRISMA Checklist (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO registration number: CRD42017059782). In November 2016 and September 2017, we searched the databases CINAHL, MEDLINE, PSYNDEX, and Web of Science. We included studies investigating psychosocial interventions for childhood cancer survivors diagnosed under the age of 21, their family members or the family as a whole. Further, we summarized the study characteristics and conducted a narrative synthesis of the results. Finally, we assessed the study quality with the Effective Public Health Practice Project Quality Assessment Tool.

Results

We identified a total of 8215 records based on our database searches and 17 additional records through hand searches. We included 33 articles in the qualitative synthesis. Most of the studies described interventions for the cancer survivor (n = 15). Nine studies investigated interventions for the whole family, and two studies interventions for siblings. The interventions mainly take place in an outpatient group setting (n = 15). Overall, most of the studies reported a significant psychosocial benefit of the interventions. However, the quality of the included studies was limited.

Conclusion

In summary, we identified a broad range of different interventions and thus could give a comprehensive overview of existing interventions for childhood cancer survivors and their families. However, there is a necessity for high quality studies. The results may help to optimize health care services that support families with the re-entry into daily life.

A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases

BACKGROUND

Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer.

METHODS

Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed.

RESULTS

A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars!

CONCLUSION

Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.

Benefits of Attending a Weekend Childhood Cancer Survivor Family Retreat

PURPOSE

To explore the long-term benefits to families of childhood cancer survivors who attended a weekend childhood cancer survivor family retreat.

DESIGN

Descriptive-qualitative study including families who had attended the weekend retreat at least once but not in the past 12 months, and who attend a large pediatric hematology and oncology cancer survivorship program in Texas.

METHODS

A semistructured interview guide was used during three audio-taped focus groups to explore the benefits of having attended a weekend retreat. Descriptive qualitative analysis was used to analyze the focus groups' transcripts.

FINDINGS

Seven families participated in the focus groups, and the themes identified were reconnecting (with others or family), putting life in perspective, and changing outlook on life.

CONCLUSIONS

Retreats offer families of cancer survivors opportunities to reconnect with others and their own family members in a therapeutic environment. These reconnections in a therapeutic environment enriched the families' positive outlooks on life and changed their perspectives.

CLINICAL RELEVANCE

Families of childhood cancer survivors report a lack of support following the completion of therapy. Retreats in a nonclinical therapeutic setting optimize family-perceived support, relationship building, and reconnecting survivor families.

Being normal, not vulnerable: case study of a 2-day residential programme for young adults with cancer

OBJECTIVES

To identify and describe the outcomes and facilitating processes of participation at 'Find Your Sense of Tumour' (FYSOT), a 2-day residential programme/conference for young people with cancer, from the perspective of professionals attending and patient representatives.

DESIGN

Case study.

SETTING

Observation of the 'Find Your Sense of Tumour' over 18s residential programme and face-to-face interviews in hospital and phone interviews.

PARTICIPANTS

Twenty-six participants - 19 professionals from hospitals across the UK who accompanied young people to FYSOT; 3 programme organisers; and 4 young people from the programme steering committee.

METHODS

Participant observation and semistructured interviews.

RESULTS

This process evaluation of an educational, social and peer-to-peer support residential weekend for young people with cancer identified key outcomes for young people - positive attitudes (increased sociability, confidence), belonging (feeling accepted, understood), recreation (trying new activities, having fun) and increased knowledge (balance between educational talks and interactions with other young people); and three overarching facilitating processes - being with other young people, the professionals accompanying young people to the event for support and guidance, and the conference/intentional programming. Being in a safe, relaxed and fun environment with other young people facilitates the development of peer support networks and increases young people's confidence and knowledge. Although the focus of the residential programme is on young people, interviewees acknowledge the impact of attending on professionals' motivation, learning and changes in practice.

CONCLUSIONS

This study has extended our understanding of the role of residential programmes by identifying outcomes and facilitating mechanisms. We have shown that residential programmes have an important role in providing participants with social, emotional and informational support, as well as play an important role in redefining normality. Longitudinal quantitative and qualitative research is needed to optimise outcomes and design and implement quality programmes that support young people's development.

Healthy cooking classes at a children's cancer hospital and patient/survivor summer camps: initial reactions and feasibility

OBJECTIVE

Childhood cancer survivors (CCS) have been shown to practise suboptimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviours in community-based programming and academic research; however, literature on teaching cooking classes in CCS is limited. The purpose of the present study was to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behaviour.

DESIGN

A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings.

SETTING

One paediatric cancer hospital inpatient unit, one paediatric cancer in-hospital camp programme and two off-site paediatric cancer summer camp programmes.

SUBJECTS

One hundred and eighty-nine CCS of varying ages and thirteen parents of CCS.

RESULTS

Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS.

CONCLUSIONS

Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS.

Assessing the experience of social support for parents who attended Camp Trillium's pediatric oncology family program

When a child is diagnosed with cancer, the entire family is affected by the demands of the illness and its treatment. This study aimed to provide a more nuanced understanding of the experience of parents of children with cancer when participating in therapeutic recreation programs (such as summer camp) and to address the specific knowledge gap of the role that camp may play in providing social support for these families. In particular, this study aimed to enroll mothers and fathers, as the voice of fathers has previously been missing in research about cancer camps.

METHOD

Qualitative methods were used to better understand the experiences of parents (n = 85) attending Camp Trillium's family program between June 26th and August 31st of 2012. Data obtained were analyzed using a grounded theory approach and thus coded and then grouped using thematic analysis. Parents reported that they experienced valuable peer interaction and experienced an increase in their perceived social support. They also stated that this support was sustained outside of the camp experience. Parents highlighted the important aspects of camp as: the empowering setting, time to escape the treatment routine, and rebuild familial relationships. From the qualitative interviews, five distinct themes were explicated: (a) empowering setting, (b) restoring family relationships, (c) valuable peer interactions, (d) information sharing, and (e) group tensions. In addition to respite and recreational opportunities, camp provides access to an environment and community that has the ability to provide sustained and empowering support for parents dealing with childhood cancer, notably for fathers.

Advancing a comprehensive cancer care agenda for children and their families: Institute of Medicine Workshop highlights and next steps

This article highlights key findings from the "Comprehensive Cancer Care for Children and Their Families" March 2015 joint workshop by the Institute of Medicine (IOM) and the American Cancer Society. This initiative convened more than 100 family members, clinician investigators, advocates, and members of the public to discuss emerging evidence and care models and to determine the next steps for optimizing quality-of-life outcomes and well-being for children and families during pediatric cancer treatment, after treatment completion, and across the life spectrum. Participants affirmed the triple aim of pediatric oncology that strives for every child with cancer to be cured; provides high-quality palliative and psychosocial supportive, restorative, and rehabilitative care to children and families throughout the illness course and survivorship; and assures receipt of high-quality end-of-life care for patients with advancing disease. Workshop outcomes emphasized the need for new pediatric cancer drug development and identified critical opportunities to prioritize palliative care and psychosocial support as an integral part of pediatric cancer research and treatment, including the necessity for adequately resourcing these supportive services to minimize suffering and distress, effectively address quality-of-life needs for children and families at all stages of illness, and mitigate the long-term health risks associated with childhood cancer and its treatment. Next steps include dismantling existing silos and enhancing collaboration between clinical investigators, disease-directed specialists, and supportive care services; expanding the use of patient-reported and parent-reported outcomes; effectively integrating palliative and psychosocial care; and clinical communication skills development. CA Cancer J Clin 2016;66:398-407. © 2016 American Cancer Society.

A multisite evaluation of summer camps for children with cancer and their siblings

Summer camps for pediatric cancer patients and their families are ubiquitous. However, there is relatively little research, particularly studies including more than one camp, documenting outcomes associated with children's participation in summer camp. The current cross-sectional study used a standardized measure to examine the role of demographic, illness, and camp factors in predicting children's oncology camp-related outcomes. In total, 2,114 children at 19 camps participated. Campers were asked to complete the pediatric camp outcome measure, which assesses camp-specific self-esteem, emotional, physical, and social functioning. Campers reported high levels of emotional, physical, social, and self-esteem functioning. There were differences in functioning based on demographic and illness characteristics, including gender, whether campers/siblings were on or off active cancer treatment, age, and number of prior years attending camp. Results indicated that summer camps can be beneficial for pediatric oncology patients and their siblings, regardless of demographic factors (e.g., gender, treatment status) and camp factors (e.g., whether camp sessions included patients only, siblings only, or both). Future work could advance the oncology summer camp literature by examining other outcomes linked to summer camp attendance, using longitudinal designs, and including comparison groups.

Play model for "evaluation of self-concept of children with cancer"

Background:

Childhood cancers are fatal diseases which cause intense stress and traumatic situations for the ones who experience those diseases. This kind of an emotionally hard life may create some hardships for developing self-concept. The aim of the study is to put forth the self-exposure of a school-age child by using plays.

Materials and Methods:

Six play sessions had been carried out in June-August 2011. As a searching pattern, interpretive case study method was used. The research consisted of six children with cancer, aged between 9 and 12 years. The research was conducted in a public hospital in children oncology service.

Results:

The assessment of data was realized in two stages. The first one was examining the data; the other stage was the content analysis that has been constructed after the play sessions as Nursing Intervention: Play Model. In the newly formed model, nine themes had been found: (a) expressing good memories, (b) control, (c) problem-solving ability, (d) relations, (e) aggressive behaviors, (f) regression, (g) good-bad, (h) trauma, and (i) anxiety.

Conclusions:

The self-concept of the school-age child needs to be supported. It has been submitted that the themes can be supportive for the prospective nursing models concerning child's self-exposure. It has been suggested that the themes produced by Nursing Intervention: Play Model can be used while planning, implementation, and assessment of the nursing care.

'Through my eyes': health-promoting factors described by photographs taken by children with experience of cancer treatment

BACKGROUND

Health promotion for children with cancer should be based on the children's own needs and desires. Because there is a lack of knowledge in this area, the aim of this study was to explore what promotes health from the perspective of children with experience of cancer treatment.

METHODS

Fifteen children between 8 and 12 years of age participated in focus groups with three children in each group. The children were given a camera and instructions to photograph subjects that promote their health. Focus group discussions were based on the photographs and the children's own description of those photographs. The analysis of focus group discussions and photographs was conducted using inductive content analysis.

RESULTS

According to the children, health-promoting factors are defined as meaningful relationships, recreational activities and a trustful environment. Meaningful relationships include togetherness within the family, affection for pets and friendship with peers. Recreational activities include engagement in play and leisure, withdrawal for relaxation and feeling enjoyment. Trustful environment includes confidence in significant others and feeling safe.

CONCLUSIONS

Knowledge from this study can contribute to health promotion interventions and quality improvements in the health care of children with experience of cancer treatment. Children's experiences with what promotes health in their everyday lives provide a better understanding of the type of support children prefer when promoting their own health.

Supporting Siblings as a Standard of Care in Pediatric Oncology

In this study, evidence is provided for supporting siblings as a standard of care in pediatric oncology. Using Medline, PsycInfo, and CINAHL, a systematic search of articles published over the past two decades about siblings of children with cancer was conducted. A total of 125 articles, which were primarily descriptive studies, were evaluated by the four investigators using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. There is moderate-quality evidence, as well as support from community stakeholders, to justify a strong recommendation that siblings of children with cancer should be provided with psychosocial services and that parents and professionals are advised about how to meet siblings' needs.

Providing Children and Adolescents Opportunities for Social Interaction as a Standard of Care in Pediatric Oncology

Experiences with peers constitute an important aspect of socialization, and children and adolescents with cancer may experience reduced social interaction due to treatment. A literature review was conducted to investigate the evidence to support a standard of care evaluating these experiences. Sixty-four articles were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Moderate quality of evidence suggest that social interaction can be beneficial to increase knowledge, decrease isolation, and improve adjustment and constitute an important, unmet need. The evidence supports a strong recommendation for youth with cancer to be provided opportunities for social interaction following a careful assessment of their unique characteristics and preferences.

Clinical and Neurobiological Perspectives of Empowering Pediatric Cancer Patients Using Videogames

Pediatric oncology patients often experience fatigue and physical and mental deconditioning during and following chemotherapy treatments, contributing to diminished quality of life. Patient empowerment is a core principle of patient-centered care and reflects one's ability to positively affect his or her own health behavior and health status. Empowerment interventions may enhance patients' internal locus of control, resilience, coping skills, and self-management of symptoms related to disease and therapy. Clinical and technological advancements in therapeutic videogames and mobile medical applications (mobile health) can facilitate delivery of the empowerment interventions for medical purposes. This review summarizes clinical strategies for empowering pediatric cancer patients, as well as their relationship with developing a “fighting spirit” in physical and mental health. To better understand physiological aspects of empowerment and to elucidate videogame-based intervention strategies, brain neuronal circuits and neurotransmitters during stress, fear, and resilience are also discussed. Neuroimaging studies point to the role of the reward system pathways in resilience and empowerment in patients. Taken together, videogames and mobile health applications open translational research opportunities to develop and deliver empowerment interventions to pediatric cancer patients and also to those with other chronic diseases.