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Psihogios AM, Roth M, Gomez C, Hekimian-Brogan E, McQueen C, Yanez B. Partnering With Social Media Influencers to Equitably Improve Adolescent and Young Adult Cancer Outcomes: A Novel Strategy to Support Cancer Care Delivery. JCO Oncol Pract 2024; 20:755-760. [PMID: 38408282 DOI: 10.1200/op.23.00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
| | - Michael Roth
- The University of Texas, MD Anderson Cancer Center, Houston, TX
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Ferrari A, Silva M, Patriccioli A, Signoroni S, Massimino M. I was only sixteen. TUMORI JOURNAL 2024; 110:209-211. [PMID: 38031728 DOI: 10.1177/03008916231214220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This short piece describes a new project developed by the adolescent patients with cancer involved in the Youth Project at the Istituto Nazionale dei Tumori in Milan, Italy. This is a scheme dedicated to young cancer patients with the dual aim of optimizing medical aspects of their care and promoting a holistic approach to their needs. "I was only sixteen" is a ballad, written in English by the patients, that became a song with the help of professional musicians (and among them international star Tony Hadley, former frontman of Spandau Ballet). This song sounds like hymn to life for teenagers with cancer in the world. It emphasizes again the value of giving young patients novel creative ways to express themselves.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alice Patriccioli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Hereditary Digestive Tract Tumors Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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3
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Ziegler E, Klein J, Kofahl C. Patient experiences and needs in cancer care- results from a nationwide cross-sectional study in Germany. BMC Health Serv Res 2024; 24:572. [PMID: 38698426 PMCID: PMC11067160 DOI: 10.1186/s12913-024-10951-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Patient-centredness has become a central quality indicator for oncology care. Elements include shared decision-making, patient navigation and integration of psychosocial care, which impact patient-reported and clinical outcomes. Despite efforts to promote patient-centred care in Germany in recent decades, implementation remains fragmented. Further, research on patient experiences with cancer care and its determinants is limited. Therefore, this study examines which patient- and facility-specific factors are associated with patient-centred quality care delivery. METHODS A cross-sectional study was conducted among 1,121 cancer patients in acute treatment, rehabilitation, and aftercare for different cancer entities across Germany. A participatory developed questionnaire was used. Outcome measures were the quality of physician-patient interaction and provision of psychosocial care during acute care. Predictors comprised patient-specific characteristics and treatment facility-specific factors. Multiple linear regression and multivariate binary logistic regression analyses were performed. In addition, a content analysis of open-ended comments on the patients' overall cancer care needs was applied. RESULTS Multiple linear regression analysis showed recent diagnosis (β=-0.12, p = < 0.001), being male (β=-0.11, p = 0.003), and having a preference for passive decision-making (β=-0.10, p = 0.001) to be significantly associated with higher interaction quality, but not age, education and health insurance type. An overall low impact of patient characteristics on interaction quality was revealed (adj. R2 = 0.03). Binary logistic regression analysis demonstrated the availability of central contact persons (OR = 3.10, p < 0.001) followed by recent diagnosis (p < 0.001), having breast cancer (p < 0.001) and being female (OR = 1.68, p < 0.05) to significantly predict offering psycho-oncological counselling to patients in acute care facilities. The availability of peer support visiting services (OR = 7.17, p < 0.001) and central contact persons (OR = 1.87, p < 0.001) in the care facility, breast cancer diagnosis (p < 0.001) and a higher level of education (p < 0.05) significantly increased the odds of patients receiving information about peer support in the treatment facility. Despite relatively satisfactory quality of physician-patient interactions in cancer care (M = 3.5 (± 1.1)), many patients expressed that better patient-centred communication and coordinated, comprehensive cancer care are needed. CONCLUSION The findings reflect effective developments and improvements in cancer care and suggest that patients' social characteristics are less decisive for delivering patient-centred quality care than systemic factors surrounding the care facilities. They can serve to inform oncology care in Germany.
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Affiliation(s)
- Elâ Ziegler
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Scott I, Oberoi S. Developing an Adolescent and Young Adult Oncology Program in a Medium-Sized Canadian Centre: Lessons Learned. Curr Oncol 2024; 31:2420-2426. [PMID: 38785462 PMCID: PMC11119119 DOI: 10.3390/curroncol31050181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
The Adolescent and Young Adult (AYA) Program at CancerCare Manitoba (CCMB) has experienced tremendous growth since its inception. This report provides an overview of how the AYA program at CCMB was established and the crucial factors that led to its early accomplishments and continued expansion. These factors included actions and decisions made at the individual and organizational level that helped lay a strong foundation for the program's sustained success. We hope that some of these lessons learned can be adapted and implemented by other oncology agencies to improve the care outcomes and experiences of AYAs living with cancer.
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Affiliation(s)
- Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Sapna Oberoi
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R2H 2A6, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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Ferrari A, Perillo T, Milano GM, Silva M, Rutigliano C, Salvo A, Livellara V, Conte M, Coccoli L, Amore E, Pierobon M, Vietina F, Pagani Bagliacca E, Spinelli M, Massei MS, Massetti V, Legnani E, Puglisi I, Zucchetti G, Quarello P. The power of art and the powers of adolescents with cancer: Age-specific projects at Italian pediatric oncology centers. TUMORI JOURNAL 2024:3008916241245005. [PMID: 38591573 DOI: 10.1177/03008916241245005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
This article describes the oncology programs developed in Italy for adolescents and young adults with cancer, with a specific focus on the local projects created in pediatric oncology centers. A common feature of such projects is the emphasis on creative and artistic activities and laboratories (involving music, photography, novel writing, fashion design, and so on) designed to give young patients innovative means of expression.This article highlights the amazing powers of adolescents involved in these projects: the power to produce beautiful things in a place that is not normally associated with the idea of beauty; the power to make their doctors smile and grasp the profound sense of life; the power to make hospitals become places for producing culture.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Teresa Perillo
- Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari, Italy
| | | | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Rutigliano
- Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari, Italy
| | - Andrea Salvo
- Hematology/Oncology, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Virginia Livellara
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Massimo Conte
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Luca Coccoli
- Pediatric Hematology-Oncology Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Elena Amore
- Pediatric Hematology-Oncology Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marta Pierobon
- Pediatric Hematology Oncology Division, University of Padua, Padua, Italy
| | - Francesco Vietina
- Pediatric Hematology Oncology Division, University of Padua, Padua, Italy
| | - Elena Pagani Bagliacca
- Pediatric Hematology-Oncology Department, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Marco Spinelli
- Pediatric Hematology-Oncology Department, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Maria Speranza Massei
- Pediatric Oncology-Hematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Massetti
- Pediatric Oncology-Hematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Legnani
- Hematology-Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ilaria Puglisi
- Hematology-Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Zucchetti
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
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Dorfman CS, Stalls JM, Arrato NA, Shelby RA, Woodward JT, Acharya K, Davidson B, Wagner L, Corbett C, Greenup RA. Adoption as an Alternative Family-Building Strategy: Perceptions of Female, Young Adult Cancer Survivors Receiving Gonadotoxic Treatments. J Adolesc Young Adult Oncol 2024. [PMID: 38588577 DOI: 10.1089/jayao.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Female survivors of young adult (YA) cancers are at risk of fertility impacts following cancer treatment. For these women, fertility-related distress is both prevalent and persistent. Yet there is little research regarding survivors' perspectives on alternative family-building options, particularly adoption. This exploratory secondary data analysis analyzed semistructured interviews and explored survivors' views of adoption. Overall, female YA survivors reported openness to adoption as a possible substitute for biological conception and an alternative to fertility preservation. It is imperative that this population receives support in decision-making around and consideration of the unique barriers to adoption for cancer survivors.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Juliann M Stalls
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Nicole A Arrato
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Julia T Woodward
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly Acharya
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brittany Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lars Wagner
- Division of Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cheyenne Corbett
- Supportive Care and Survivorship Center, Duke Cancer Institute, Durham, North Carolina, USA
| | - Rachel A Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Schwartz-Attias I, David T, Amromin T, Bar-Yosef M, Bartov Y, Ben Yaakov O, Bernstein L, Broitman M, Cohen A, Cohen O, Eisenberg L, Eshel N, Gindi Amsalem N, Gorelik N, Gerbi S, Raz H, Naamneh N, Nemtsov S, Pintel D, Sztrigler K, Goldberg S, Melnikov S. Recommendations from the Professional Advisory Committee on Nursing Practice When Caring for Adolescents and Young Adults with Cancer in Israel. J Adolesc Young Adult Oncol 2024; 13:235-238. [PMID: 37889616 DOI: 10.1089/jayao.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Affiliation(s)
- Irit Schwartz-Attias
- Academic Nursing School, Meir Medical Center, Clalit Health Services, Kefer-Sava, Israel
| | - Tova David
- Nursing Administration and Hematology Day Care, Assuta Medical Center, Tel Aviv, Israel
| | | | - Michal Bar-Yosef
- Department of Oncology and Pediatric Hematology Oncology and Bone Marrow Transplantation, Sourasky, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Yael Bartov
- Ziva Tal Academic School of Nursing and AYA Clinical Day Care and Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Orna Ben Yaakov
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | | | - Marcela Broitman
- Department of Oncology and Pediatric Hematology Oncology and Bone Marrow Transplantation, Sourasky, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Amira Cohen
- Nursing Administration, Shamir Medical Center, Tzrifin, Israel
| | - Osnat Cohen
- Department of Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Limor Eisenberg
- National Head Nurse Office, Nursing Division, Ministry of Health, Jerusalem, Israel
| | - Nurit Eshel
- Nursing Administration, Clalit Health Services, Tel Aviv, Israel
| | - Nati Gindi Amsalem
- Ziva Tal Academic School of Nursing and AYA Clinical Day Care and Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Natan Gorelik
- Nursing Administration and Hematology Day Care, Assuta Medical Center, Tel Aviv, Israel
| | - Shimrit Gerbi
- Ziva Tal Academic School of Nursing and AYA Clinical Day Care and Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Haya Raz
- Nursing Department, Jerusalem College of Technology, Jerusalem, Israel
| | - Nahla Naamneh
- Nursing Administration, Leumit Health Care Services, Tel Aviv, Israel
| | - Svetlana Nemtsov
- Department of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Dalit Pintel
- Nursing Administration, Clalit Health Services, Tel Aviv, Israel
| | - Keren Sztrigler
- Pediatric Hematology-Oncology Day Care, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shoshy Goldberg
- National Head Nurse Office, Nursing Division, Ministry of Health, Jerusalem, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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8
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Hughes L, Taylor RM, Beckett AE, Lindner OC, Martin A, McCulloch J, Morgan S, Soanes L, Uddin R, Stark DP. The Emotional Impact of a Cancer Diagnosis: A Qualitative Study of Adolescent and Young Adult Experience. Cancers (Basel) 2024; 16:1332. [PMID: 38611010 PMCID: PMC11010824 DOI: 10.3390/cancers16071332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
The biographical disruption that occurs in adolescents and young adults following a cancer diagnosis can affect various important psychosocial domains including relationships with family and friends, sexual development, vocational and educational trajectories, and physical and emotional wellbeing. While there is evidence of the physical impact of cancer during this period, less is known about the impact on emotional wellbeing and especially on the barriers for young people accessing help and support. We aimed to obtain a more in-depth understanding of young people's experiences of their diagnosis, treatment, psychological impact, and range of resources they could or wanted to access for their mental health. We conducted an in-depth qualitative study using semi-structured interviews with 43 young people who had developed cancer aged 16 to 39 years and were either within 6 months of diagnosis or 3-5 years after treatment had ended. Framework analysis identified three themes: the emotional impact of cancer (expressed through anxiety, anger, and fear of recurrence); personal barriers to support through avoidance; and support to improve mental health through mental health services or adolescent and young adult treatment teams. We showed the barriers young people have to access care, particularly participant avoidance of support. Interrupting this process to better support young people and provide them with flexible, adaptable, consistent, long-term psychological support has the potential to improve their quality of life and wellbeing.
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Affiliation(s)
- Luke Hughes
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Rachel M. Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
- Department of Targeted Intervention, University College London, London WC1E 6BT, UK
| | - Angharad E. Beckett
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, UK; (A.E.B.); (J.M.)
| | - Oana C. Lindner
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9JT, UK;
| | - Joanne McCulloch
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, UK; (A.E.B.); (J.M.)
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Leeds Teaching Hospitals NHS Foundation Trust, Leeds LS9 7TF, UK;
| | | | - Rizwana Uddin
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
| | - Dan P. Stark
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (R.U.); (D.P.S.)
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Kirchhoff AC, Waters AR, Chevrier A, Wolfson JA. Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature. J Clin Oncol 2024; 42:642-652. [PMID: 37939320 DOI: 10.1200/jco.23.01027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 11/10/2023] Open
Abstract
Access to care remains a persistent challenge for adolescents and young adults (AYAs) with cancer. We review key findings in the science to date. (1) Location of care matters. There is survival benefit for AYAs treated either at a pediatric center or site with special status (eg, Children's Oncology Group, National Cancer Institute [NCI]-designated Comprehensive Cancer Center). (2) Socioeconomic status and insurance require further investigation. Medicaid expansion has had a moderate effect on AYA outcomes. The dependent care expansion benefit has come largely from improvements in coverage for younger populations whose parents have insurance, while some subgroups likely still face insurance gaps. (3) Clinical trial enrollment remains poor, but access may be improving. Numerous barriers and facilitators of clinical trial enrollment include those that are system level and patient level. NCI has established several initiatives over the past decade to improve enrollment, and newer collaboratives have recently brought together multidisciplinary US teams to increase clinical trial enrollment. (4) Effective AYA programs require provider and system flexibility and program reflection. With flexibility comes a need for metrics to assess program effectiveness in the context of the program model. Centers treating AYAs with cancer could submit a subset of metrics (appropriate to their program and/or services) to maintain their status; persistence would require an entity with staying power committed to overseeing the metrics and the system. Substantial clinical and biological advances are anticipated over the next 20 years that will benefit all patients with cancer. In parallel, it is crucial to prioritize research regarding access to health care and cancer care delivery; only with equitable access to care for AYAs can they, too, benefit from these advances.
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Affiliation(s)
- Anne C Kirchhoff
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Amy Chevrier
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Julie A Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Law K, Harris E, McCabe MG, Yorke J, van der Veer SN. Measurement Properties of Patient-Reported Outcome Measures for Adolescent and Young Adult Survivors of a Central Nervous System Tumor: A Systematic Review. J Adolesc Young Adult Oncol 2024; 13:40-54. [PMID: 37307017 PMCID: PMC10877386 DOI: 10.1089/jayao.2023.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Purpose: To identify and evaluate patient-reported outcome measures (PROMs) for assessing survivorship-related concepts for adolescent and young adult (AYA) survivors of central nervous system (CNS) tumors. Methods: We searched five electronic databases. Two researchers independently screened all titles for inclusion and used consensus-based standards for the selection of health measurement instruments (COSMIN) guidance to grade the quality of evidence for each measurement property. Results: Four studies met eligibility criteria: single-item pain thermometer; single-item fatigue thermometer; 37-item pediatric functional assessment of cancer therapy-brain tumor survivors, measuring quality of life; and 12-item Perceived Barriers Scale to assess barriers to employment. The Perceived Barrier Scale showed high-quality evidence for internal consistency and moderate quality evidence for construct and structural validity. Evidence for the measurement properties of the other PROMs was low-to-moderate quality. Conclusion: We found one PROM with sufficient evidence for good measurement properties to support its use. This warrants development and evaluation of further PROMs to inform ongoing supportive care for this population. Implications for Cancer Survivors: The Perceived Barriers Scale is sufficiently validated and could be considered to guide support for AYA survivors of CNS tumors to achieve their employment goals.
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Affiliation(s)
- Kate Law
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Emily Harris
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Martin G. McCabe
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Sabine N. van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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11
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Schilstra CE, Sansom-Daly UM, Ellis SJ, Trahair TN, Anazodo AC, Amiruddin A, Lindsay T, Maguire F, Wakefield CE, Lah S, Bland E, Lenthen K, Rifkin A, Awan A, Kittos T, Hanbury N, Tsalidis S, Patterson P, McDonald F, Fardell JE. Guidelines for Caring for the Social Well-Being of Adolescents and Young Adults with Cancer in Australia. J Adolesc Young Adult Oncol 2024; 13:8-29. [PMID: 37367208 DOI: 10.1089/jayao.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
More than 1000 Australian adolescents and young adults (AYAs) are diagnosed with cancer annually. Many report unmet social well-being needs, which impact their mental health. Australian AYA cancer care providers lack guidance to address these needs well. We aimed to develop guidelines for caring for the social well-being of AYAs with cancer in Australia. Following the Australian National Health and Medical Research Council guidance, we formed a multidisciplinary working group (n = 4 psychosocial researchers, n = 4 psychologists, n = 4 AYA cancer survivors, n = 2 oncologists, n = 2 nurses, and n = 2 social workers), defined the scope of the guidelines, gathered evidence via a systematic review, graded the evidence, and surveyed AYA cancer care providers about the feasibility and acceptability of the guidelines. The guidelines recommend which AYAs should have their social well-being assessed, who should lead that assessment, when assessment should occur with which tools/measures, and how clinicians can address AYAs' social well-being concerns. A key clinician, who is knowledgeable about AYAs' developmental needs, should lead the assessment of social well-being during and after cancer treatment. The AYA Psycho-Oncology Screening Tool is recommended to screen for social well-being needs. The HEADSSS Assessment (Home, Education/Employment, Eating/Exercise, Activities/Peer Relationships, Drug use, Sexuality, Suicidality/Depression, Safety/Spirituality Assessment) can be used for in-depth assessment of social well-being, while the Social Phobia Inventory can be used to assess social anxiety. AYA cancer care providers rated the guidelines as highly acceptable, but discussed many feasibility barriers. These guidelines provide an optimal care pathway for the social well-being of AYAs with cancer. Future research addressing implementation is critical to meet AYAs' social well-being needs.
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Affiliation(s)
- Clarissa E Schilstra
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Sydney Youth Cancer Service, Prince of Wales Hospital, Sydney, Australia
| | - Sarah J Ellis
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Toby N Trahair
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Antoinette C Anazodo
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Azhani Amiruddin
- Western Sydney Youth Cancer Service, Westmead Hospital, Wentworthville, Australia
| | | | - Fiona Maguire
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Sydney Youth Cancer Service, Prince of Wales Hospital, Sydney, Australia
| | - Claire E Wakefield
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Suncica Lah
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Elizabeth Bland
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | | | - Allison Rifkin
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Adry Awan
- Cancer Survivor and Advisor, Sydney, Australia
| | | | | | | | - Pandora Patterson
- Canteen, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Fiona McDonald
- Canteen, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Joanna E Fardell
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Western Sydney Youth Cancer Service, Westmead Hospital, Wentworthville, Australia
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12
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Husson O, Janssen SHM, Reeve BB, Sodergren SC, Cheung CK, McCabe MG, Salsman JM, van der Graaf WTA, Darlington AS. Protocol for the development of a Core Outcome Set (COS) for Adolescents and Young Adults (AYAs) with cancer. BMC Cancer 2024; 24:126. [PMID: 38267900 PMCID: PMC10809623 DOI: 10.1186/s12885-023-11716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer, defined as individuals aged 15-39 years at initial cancer diagnosis, form a unique population; they face age-specific issues as they transition to adulthood. This paper presents the protocol for the development of a core outcome set (COS) for AYAs with cancer. METHODS The methodological standards from the Core Outcome Measures in Effectiveness Trials (COMET) and the International Consortium for Health Outcomes Measurement (ICHOM) for COS development will guide the development of the COS for AYAs with cancer. The project will consist of the following phases: (1) define the scope of the COS; (2) establish the need for a COS in this field (3) assemble an international, multi-stakeholder working group; (4) develop a detailed protocol; (5) determine "what to measure" (i.e., outcomes); (6) determine "how to measure" (i.e., measures); and (7) determine "case-mix" variables. CONCLUSIONS The development of a COS for AYAs with cancer will facilitate the implementation of efficient and relevant standards for data collection, both for clinical trials and in routine healthcare, thereby increasing the usefulness of these data to improve the value of the care given to these underserved young cancer patients.
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Affiliation(s)
- Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Silvie H M Janssen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | | | | | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - John M Salsman
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, USA
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Mailankody S, Bajpai J, Arora PR, Sreedharan R, Chitalkar P, Kurkure P, Malhotra H, Parikh FR, Gupta S, Banavali SD. Oncofertility and Pregnancy in Adolescent and Young Adult Cancers: Physicians' Knowledge and Preferences in India. JCO Glob Oncol 2024; 10:e2300205. [PMID: 38207248 DOI: 10.1200/go.23.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/11/2023] [Accepted: 11/03/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The treatment outcomes of adolescent and young adult (AYA) cancers have improved with advanced oncology care. Hence, fertility preservation (FP) and post-therapy pregnancies (PTPs) become vital issues. MATERIALS AND METHODS An online survey link with 17 questions regarding oncofertility and PTPs was circulated among oncologists to assess the knowledge, understand the oncofertility care patterns, and seek suggestions to improve oncofertility services. RESULTS The median age of 179 respondents, predominantly medical oncologists (68.7%), was 37 years (IQR, 10; range, 29-74), working in academic centers (39%) having a median experience of 4 years (IQR, 4; range, 1-42); 23 (12.8%) had dedicated AYA cancer units. Although a quarter (19%-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8%-11%) refer >90% for FP, with significantly higher (P < .05) discussions and referrals in males and by more experienced oncologists (P < .05). Forty-six (25.6%) were not well versed with international guidelines for FP. Most (122, 68.1%) oncologists knew about the referral path for semen cryopreservation; however, only 46% were knowledgeable about additional complex procedures. One hundred and ten (61.5%) oncologists never or rarely altered the systemic treatment for FP. Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices are education, and enhanced and affordable access to FP facilities. Seventy-four (41.3%) respondents knew about international guidelines for PTPs; however, only half (20%) of them often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and pregnancy outcomes among survivors. CONCLUSION Oncologists are uncertain about the guidelines, FP practices, referral pathways, and PTPs. Multipronged approaches to improve awareness and provision for affordable oncofertility facilities are needed to enhance AYA cancer outcomes in India, which will be applicable to other low- and middle-income countries too.
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Affiliation(s)
- Sharada Mailankody
- Department of Medical Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Puneet R Arora
- Center for Infertility and Assisted Reproduction (CIFAR), Gurugram, India
| | | | - Prakash Chitalkar
- Department of Medical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, India
| | - Purna Kurkure
- Oncology Collegium, Narayana Health, SRCC Children Hospital, Mumbai, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, India
| | - Firuza R Parikh
- IVF and Reproductive Medicine, Jaslok Hospital, Mumbai, India
- Well Women Centre, HN Reliance Hospital, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, India
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Byrne EM, Pascoe M, Cooper D, Armstrong TS, Gilbert MR. Challenges and limitations of clinical trials in the adolescent and young adult CNS cancer population: A systematic review. Neurooncol Adv 2024; 6:vdad159. [PMID: 38250563 PMCID: PMC10798804 DOI: 10.1093/noajnl/vdad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background The adolescent and young adult (AYA) cancer population, aged 15-39, carries significant morbidity and mortality. Despite growing recognition of unique challenges with this age group, there has been little documentation of unmet needs in their care, trial participation, and quality of life, particularly in those with primary brain tumors. Methods A systematic literature review of 4 databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Studies included editorials, reviews, and practice guidelines on the challenges and limitations faced by the AYA population. Papers had to address CNS tumors. Results Sixty-eight studies met the inclusion criteria. The challenges and limitations in clinical trials in the AYA population were synthesized into 11 categories: molecular heterogeneity, tumor biology, diagnostic delay, access to care, physician factors, patient factors, primary brain tumor (PBT) factors, accrual, limited trials, long term follow up, and trial design. The published papers' recommendations were categorized based on the target of the recommendation: providers, coordination of care, organizations, accrual, and trial design. The AYA cancer population was found to suffer from unique challenges and barriers to care and the construction of trials. Conclusions The AYA CNS cancer population suffers from unique challenges and barriers to care and construction of trials that make it critical to acknowledge AYAs as a distinct patient population. In addition, AYAs with primary brain tumors are underrecognized and underreported in current literature. More studies in the AYA primary brain tumor patient population are needed to improve their care and participation in trials.
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Affiliation(s)
- Emma M Byrne
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Maeve Pascoe
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Diane Cooper
- National Institute of Health Library, National Institute of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
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15
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Daniels S, Bartholomew E, Chambliss H. Development of the Together - Teens&20s microsite, an online resource for adolescent and young adult cancer patients. PEC INNOVATION 2023; 3:100235. [PMID: 38213758 PMCID: PMC10782112 DOI: 10.1016/j.pecinn.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 01/13/2024]
Abstract
Objectives The purpose of this study was to explore the information needs and preferences of adolescent and young adult (AYA) cancer patients to guide next steps for development of a new online resource for this audience. The goals were to understand information needs, prioritize topic areas, and inform website design and functionality. Methods Participants were AYA cancer patients ages 13-25 years. We used multiple methods in two phases to gather audience feedback. The first phase collected quantitative data in an electronic survey (n = 45) about AYA patients' internet use and content preferences. The second phase collected qualitative data through focus groups (n = 13) about user preferences for content design and website function. Results Survey results showed AYA patients were more interested in content about how treatments would impact their lives rather than the treatments themselves. They preferred content on school, careers, relationships, independence, side effects, and fertility. The focus groups indicated AYA patients prefer a clean, stylish design; infographics and visual aids; and the ability to find information quickly and control the amount they read. Conclusions Online resources represent an important opportunity to advance cancer education for AYA patients. However, it is important to consider the information needs and preferences of this audience in content design and delivery. Innovation Practitioners should use stakeholder input to guide the creation of patient education resources that are age- and audience-appropriate. This study provides insights into AYA information needs and preferences in pediatric oncology.
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Affiliation(s)
- Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS 121, Memphis, TN 38105, USA
| | - Elizabeth Bartholomew
- Department of Strategic Communications, Education, and Outreach, St. Jude Children's Research Hospital, Memphis, USA
| | - Heather Chambliss
- Department of Strategic Communications, Education, and Outreach, St. Jude Children's Research Hospital, Memphis, USA
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Haines ER, Lux L, Stein J, Swift C, Matson M, Childers J, Kleissler D, Mayer DK, Steiner N, Steiner L, Rosenstein D, Gold S, Smitherman AB. Developing a Comprehensive Adolescent and Young Adult Cancer Program: Lessons Learned from 7 Years of Growth and Progress. J Adolesc Young Adult Oncol 2023; 12:868-878. [PMID: 37155196 PMCID: PMC10777816 DOI: 10.1089/jayao.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Purpose: Every year, nearly 100,000 adolescents and young adults (15-39 years, AYAs) are diagnosed with cancer in the United States and many have unmet physical, psychosocial, and practical needs during and after cancer treatment. In response to demands for improved cancer care delivery for this population, specialized AYA cancer programs have emerged across the country. However, cancer centers face multilevel barriers to developing and implementing AYA cancer programs and would benefit from more robust guidance on how to approach AYA program development. Methods: To contribute to this guidance, we describe the development of an AYA cancer program at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center. Results: We summarize the evolution of UNC's AYA Cancer Program since it was established in 2015, offering pragmatic strategies for developing, implementing, and sustaining AYA cancer programs. Conclusion: The development of the UNC AYA Cancer Program since 2015 has generated many lessons learned that we hope may be informative to other cancer centers seeking to build specialized services for AYAs.
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Affiliation(s)
- Emily R. Haines
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Jacob Stein
- Division of Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Catherine Swift
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Melissa Matson
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Julie Childers
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Daniel Kleissler
- Office of Clinical and Translational Research in Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lucy Steiner
- Be Loud! Sophie Foundation, Chapel Hill, North Carolina, USA
| | - Donald Rosenstein
- Comprehensive Cancer Support Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Stuart Gold
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Andrew B. Smitherman
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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Patterson P, Jacobsen RL, McDonald FE, Pflugeisen CM, Bibby K, Macpherson CF, Thompson K, Murnane A, Anazodo A, Sansom-Daly UM, Osborn MP, Hayward A, Kok C, Johnson RH. Beyond Medical Care: How Different National Models of Care Impact the Experience of Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2023; 12:859-867. [PMID: 37219896 PMCID: PMC10739785 DOI: 10.1089/jayao.2022.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Patient experience is positively associated with clinical effectiveness, quality care, and patient safety. This study examines the experience of care of adolescents and young adult (AYA) cancer patients from Australia and the United States, allowing a comparison of patient experiences in the context of different national models of cancer care delivery. Participants (n = 190) were aged 15-29 years and received cancer treatment from 2014 to 2019. Australians (n = 118) were recruited nationally by health care professionals. U.S. participants (n = 72) were recruited nationally via social media. The survey included demographic and disease variables, and questions regarding medical treatment, information and support provision, care coordination, and satisfaction across the treatment pathway. Sensitivity analyses examined the possible contribution of age and gender. Most patients from both countries were satisfied or very satisfied with their medical treatment (chemotherapy, radiotherapy, and surgery). There were significant differences between countries in the provision of fertility preservation services, age-appropriate communication, and psychosocial support. Our findings suggest when a national system of oversight with both state and federal funding is implemented, as is the case in Australia but not in the United States, significantly more AYAs with cancer receive age-appropriate information and support services, and improved access to specialist services such as fertility care. A national approach with government funding and centralized accountability appears to be associated with substantial benefits for the well-being of AYAs undergoing cancer treatment.
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Affiliation(s)
- Pandora Patterson
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca L. Jacobsen
- Mary Bridge Children's Hospital, MultiCare Health System, Tacoma, Washington, USA
| | - Fiona E.J. McDonald
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Chaya M. Pflugeisen
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, USA
| | - Kit Bibby
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
| | | | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Australia
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Australia
| | | | - Ursula M. Sansom-Daly
- NSW/ACT Youth Cancer Service, Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Sydney, Australia
| | - Michael P. Osborn
- SA/NT Youth Cancer Service, Adelaide, Australia
- Haematology/Oncology, Women's and Children's Hospital, North Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Cindy Kok
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
| | - Rebecca H. Johnson
- Mary Bridge Children's Hospital, MultiCare Health System, Tacoma, Washington, USA
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Burgers VWG, Reuvers MJP, Taphoorn MJB, Kok M, de Langen AJ, van den Bent MJ, Frissen SAMM, Harthoorn NCGL, Dickhout A, Husson O, van der Graaf WTA. A qualitative study on the healthcare experiences of adolescents and young adults (AYA) with an uncertain or poor cancer prognosis. Support Care Cancer 2023; 31:721. [PMID: 38008874 DOI: 10.1007/s00520-023-08149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Treatment advancements have improved life expectancy for adolescents and young adults (AYAs) with an uncertain and/or poor cancer prognosis (UPCP) and change clinical practice. This improved survival requires a different approach and specific expertise to meet the needs of this group. The aim of this study is to explore the health care experiences of AYAs with a UPCP. METHODS We conducted a multicenter qualitative study using semi-structured interviews and elements of the grounded theory by Corbin and Strauss. RESULTS Interviews were conducted with 46 AYAs with a UPCP. They were on average 33.4 years old (age range 23-44), and most of them were woman (63%). Additionally, five AYAs with a UPCP participated as AYA research partners in two focus groups. They were on average 31.8 years old and four of them were woman. AYAs with a UPCP reported four pillars for a satisfied healthcare experience: (1) trust, (2) tailored communication, (3) holistic empathic open attitude, and (4) care being offered (pro-)actively. They reported both optimal and suboptimal experiences about distrust based on a delay in diagnostic trajectory, lack of tailored communication and discussion of sensitive topics, preference for a holistic approach, and struggles with finding the way to get additional healthcare support. CONCLUSION For AYAs with a UPCP, it is important that both age-specific issues and issues related to the UPCP are understood and addressed; however, this seems not yet optimally implemented in clinical practice. This emphasizes the importance of providing this patient group with tailored care incorporating both aspects. Healthcare professionals need to be supported with training and tools to understand the healthcare needs of AYAs with a UPCP. AYAs can be empowered to take more control over their own healthcare needs.
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Affiliation(s)
- Vivian W G Burgers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Milou J P Reuvers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Annemiek Dickhout
- AYA Research Partner, Amsterdam, the Netherlands
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW-School of Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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Hossain N, Prashad M, Huszti E, Li M, Alibhai S. Age-related differences in symptom distress among patients with cancer. J Geriatr Oncol 2023; 14:101601. [PMID: 37597295 DOI: 10.1016/j.jgo.2023.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/12/2023] [Accepted: 08/01/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Differences in symptom distress among older (age 65-74) and very old (age 75+) patients with cancer, compared to younger patients, remain to be well explored. These differences are important to understand given the heterogeneity of older populations and may have implications for age-appropriate symptom detection and management. MATERIALS AND METHODS We examined routinely collected Edmonton Symptom Assessment System Revised (ESAS-r) scores from 9,143 patients age 40+ initiating chemotherapy for solid malignancies at a single academic cancer centre, between September 2011 and May 2019. We used multivariable logistic regression models to determine associations between the most common symptoms and age group (ages 40-64, 65-74, 75-84, and 85+), cancer site, clinical stage, sex, and income levels. We focused our findings on patients with the five most common cancers, breast (n = 1,532), prostate (n = 923), lung (n = 889), pancreatic (n = 429), and colorectal (n = 368), prior to receiving treatment. RESULTS Within our sample, 58.0% were age 40-64, 27.3% age 65-74, 11.8% age 75-84, and 2.9% age 85+. Among the nine symptoms in the ESAS-r (anxiety, depression, tiredness, wellbeing, nausea, pain, drowsiness, appetite, and shortness of breath), the most common symptoms overall were anxiety (moderate-severe scores [ESAS-r 4 or higher] were reported by 33.8% of patients), lack of well-being (38.3%), and tiredness (38.3%). Older age was associated with lower odds of moderate/severe anxiety (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.73-0.90 for age 65-74; OR 0.81, 95%CI 0.70-0.93 for age 75-84; OR 0.62, 95%CI 0.47-0.82 for age 85+; referent is 40-64-year-olds for all analyses), and increased odds of tiredness (OR 1.00, 95%CI 0.90-1.11 for age 65-74; OR 1.19, 95%CI 1.04-1.37 for age 75-84; and OR 1.34, 95%CI 1.04-1.72 for age 85+). Advanced stage, female sex, and lower income levels were associated with higher odds of moderate/severe tiredness, anxiety, and lack of well-being in adjusted models. Patients with pancreatic and lung cancers reported worse scores for these three symptoms than patients with other cancers. DISCUSSION Older age was associated with differences in symptom experiences such as increased tiredness and reduced anxiety. Supportive care interventions and future research should focus on addressing these symptoms to improve patient quality of life.
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Affiliation(s)
- Nazia Hossain
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Michael Prashad
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir Alibhai
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Toner K, Allen CE, Jain S, Kahl B, Leonard J, Wasserstrom H, Friedberg JW, Seibel NL, Kelly K. Overcoming barriers to drug development and enrollment in clinical trials for adolescents and young adults with lymphoma. EJHAEM 2023; 4:921-926. [PMID: 38024612 PMCID: PMC10660108 DOI: 10.1002/jha2.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023]
Abstract
Lymphoma is one of the most common cancers in adolescents and young adults, but historically, this population has had lower clinical trial enrollment and improvements in overall survival as compared to other age populations. There are multiple challenges that are unique to this population that have affected drug development and clinical trial enrollment. Our panel of experts have identified barriers, and in this review, we discuss current methods to address these barriers as well as potential solutions moving forward.
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Affiliation(s)
- Keri Toner
- Center for Cancer and Blood DisordersChildren's National HospitalWashingtonDistrict of ColumbiaUSA
| | - Carl E. Allen
- Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Shweta Jain
- Clinical DevelopmentSeagen Inc.BothellWashingtonUSA
| | - Brad Kahl
- Department of MedicineDivision of OncologyWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | - John Leonard
- Weill Department of MedicineDivision of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Heather Wasserstrom
- Clinical Development Team PediatricsHematology and Cellular Therapy at Bristol Myers SquibbNew YorkNew YorkUSA
| | | | - Nita L. Seibel
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Kara Kelly
- Roswell Park Comprehensive Cancer CenterUniversity at Buffalo Jacobs School of Medicine and Biomedical SciencesBuffaloNew YorkUSA
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Baclig NV, Comulada WS, Ganz PA. Mental health and care utilization in survivors of adolescent and young adult cancer. JNCI Cancer Spectr 2023; 7:pkad098. [PMID: 37982744 PMCID: PMC10735415 DOI: 10.1093/jncics/pkad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Adolescent and young adult cancer survivors experience mental health challenges, yet little is known about the evolution of these difficulties. This study explored mental health symptoms and utilization among long-term adolescent and young adult cancer survivors. METHODS Using 30 432 respondents from the 2019 National Health Interview Survey, this study compared adults with a history of adolescent and young adult cancer (diagnosed when patients were between 15 and 39 years of age) to adults without adolescent and young adult cancer. Mental health symptom severity was measured using the Patient Health Questionnaire depression scale and 7-item Generalized Anxiety Disorder questionnaires. Care utilization constituted psychotherapy and mental health medication use. Inverse propensity score weights were used to balance demographics and combined with survey weights. Descriptive statistics, multivariable generalized linear models, and structural equation modeling with 2-sided tests were used for analysis. RESULTS We compared 639 adolescent and young adult survivors with 29 793 controls. Survivors were, on average, 20.5 years (SE = 0.74) past their cancer diagnosis dates. After adjusting for survey and propensity score weights, adolescent and young adult survivors reported more severe depression (incidence rate ratio = 1.42, 95% confidence interval [CI] = 1.09 to 1.84, P < .01) and anxiety (incidence rate ratio = 1.85, 95% CI = 1.55 to 2.21, P < .001). They were more likely to use psychotherapy (odds ratio = 1.91, 95% CI = 1.16 to 3.17, P < .05) and mental health medications (odds ratio = 1.89, 95% CI = 1.15 to 3.11, P < .05). Time since diagnosis was negatively associated with symptoms and utilization. Structural equation modeling demonstrated mediation of utilization effect by symptom severity. CONCLUSIONS Adolescent and young adult survivors experience worse mental health in late survivorship, despite small improvements over time. We highlight the importance of survivorship care that addresses the long-term mental health needs of these survivors.
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Affiliation(s)
- Nikita V Baclig
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Warren Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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22
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Young K, Cashion C, Hassall T, Ekberg S, Bradford N. Supporting families through paediatric brain tumour: Unmet needs and suggestions for change. Psychooncology 2023; 32:942-950. [PMID: 37081572 PMCID: PMC10946516 DOI: 10.1002/pon.6136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE From diagnosis and beyond, a paediatric brain tumour and its treatment impact the child and their family in a myriad of ways. While it is considered best practice to offer ongoing psychosocial support for all family members, there is little scholarly investigation of both families' experiences and the practical implications of offering such care. We aimed to explore families' experiences of paediatric brain tumour and their associated psychosocial health service needs. METHODS Families receiving care at the Queensland Children's Hospital in Brisbane, Australia, for a child (0-18 years) who had been diagnosed with a brain tumour between 2019 and 2022 were invited to be interviewed about their experiences. Using qualitative description, we analysed these interviews to identify families' unmet psychosocial health service needs and their suggestions for improvement. RESULTS Twenty-three clinically and socially diverse families were represented. While parents/carers expressed gratitude for the care their child had received, most also described unmet needs for the broader family. We identified three primary needs to be addressed: (1) parents want accessible psychological/emotional support for themselves; (2) parents/carers want additional guidance to navigate the hospital setting to reduce uncertainty and loss of control; and (3) parents want support to minimise treatment-associated trauma for their child. CONCLUSIONS Our findings evidence the need for improved family-centred psychosocial care within paediatric brain tumour care in Queensland, Australia. We propose a counselling and care coordination intervention to support parents/carers to care for themselves, their child, and their family through an extremely challenging experience.
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Affiliation(s)
- Kate Young
- Cancer and Palliative Care Outcomes CentreCentre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Christine Cashion
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
- Children's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Timothy Hassall
- Children's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Stuart Ekberg
- Children's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
- School of Psychology & CounsellingQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes CentreCentre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Centre for Children's Health ResearchChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
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23
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Sansom-Daly UM, Zhang M, Evans HE, McLoone J, Wiener L, Cohn RJ, Anazodo A, Patterson P, Wakefield CE. Adapting the Voicing My CHOiCES Advance Care Planning Communication Guide for Australian Adolescents and Young Adults with Cancer: Appropriateness, Acceptability, and Considerations for Clinical Practice. Cancers (Basel) 2023; 15:2129. [PMID: 37046790 PMCID: PMC10093261 DOI: 10.3390/cancers15072129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
Background: Adolescents and young adults (AYAs) with life-threatening illnesses need support to discuss and voice their end-of-life choices. Voicing My CHOiCES (VMC) is a research-informed American advanced care planning guide designed to help facilitate these difficult discussions. This multi-perspective study aimed to evaluate its appropriateness, acceptability, and clinical considerations for Australian AYAs with cancer. Procedure: Forty-three participants including AYAs who were either undergoing or recently completed cancer treatment, their parents, and multidisciplinary health professionals assessed the acceptability of each VMC section quantitatively (appropriateness-yes/no, helpfulness and whether content caused stress-1 = not at all, to 5 = very) and qualitatively (sources of stress). AYAs also assessed the benefit and burden of completing several sections of the document, to inform clinical considerations. We conducted a mixed-methods analysis to obtain descriptive statistics and to identify prominent themes. Results: In terms of acceptability, almost all participants (96%) rated VMC as appropriate overall. Perceived helpfulness to their situation (to themselves/their child/their patients), to others, and stressfulness were rated, on average, as 4.1, 4.0, and 2.7/5, respectively. Stress was attributed to individual and personal factors, as well as interpersonal worries. All sections were considered more beneficial than burdensome, except for the Spiritual Thoughts section (Section 6). Conclusions: While VMC is an acceptable advance care planning guide for AYAs with cancer, changes to the guide were suggested for the Australian context. Health professionals implementing VMC will need to address and mitigate anticipated sources of stress identified here. Future research evaluating the impact of a new culturally adapted Australian VMC guide is an important next step. Finally, the clinical implications of the present study are suggested.
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Affiliation(s)
- Ursula M. Sansom-Daly
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Megan Zhang
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Holly E. Evans
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Jordana McLoone
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Lori Wiener
- National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard J. Cohn
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Antoinette Anazodo
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Pandora Patterson
- Canteen Australia, Sydney, NSW 2042, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Claire E. Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, NSW 2052, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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24
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Garrido Colino C, Andión Catalán M, Molinés Honrubia A, Ortega Acosta MJ, García Abos M, Juan Ribelles A, Vagace Valero JM. Adolescent cancer care: What has changed in Spain in the past decade? An Pediatr (Barc) 2023; 98:129-135. [PMID: 36697331 DOI: 10.1016/j.anpede.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In 2012, the Adolescents with Cancer Working Group published the results of a survey on care delivery for the adolescent population in Spain as a starting point for future intervention. The aim of this nationwide survey was to outline the current situation and assess whether the implemented strategies have resulted in changes in care delivery. MATERIAL AND METHODS Survey consisting of the same items analysed and published in 2012. The questionnaire was structured into sections devoted to epidemiology, psychosocial care, infrastructure, treatment and follow-up of adolescents with cancer. It was submitted to all hospitals in Spain with a paediatric haematology and oncology unit. We conducted a descriptive analysis of the results. RESULTS The percentage of patients aged up to 18 years managed in paediatric units has increased from 35.9% to 77.5% in the past decade. The proportion of malignant blood tumours treated in paediatric units increased from 31% to 52%, and the proportion of solid tumours from 49% to 85%. In 2012, 30 units (out of 39) reported that new cases in adolescents amounted to up to 10% of the total. At present, only 14 (out of 40) continue to report this percentage. A decade ago, there were no specific adolescent cancer units in Spain. Now, 7 centres (out of 40) have specific multidisciplinary units. There has been little change in psychological support services for adolescents. The follow-up of survivors is carried out by paediatric specialists in 82.5% of the hospitals. CONCLUSIONS The efforts made to centralise the care of adolescents with cancer in specific multidisciplinary adolescent units or, failing that, paediatric units, is reflected in the changes in care delivery in Spain in the past decade. Much remains to be done in key components of the management of adolescents with cancer.
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25
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Atención al adolescente con cáncer. ¿Qué ha cambiado en nuestro país en una década? An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Gruen LJ, Lee-Miller CA, Osman F, Parkes A. Benefit of Interdisciplinary Care in Resource Identification in an Adolescent and Young Adult Oncology Care Model. J Adolesc Young Adult Oncol 2023; 12:752-757. [PMID: 36595361 DOI: 10.1089/jayao.2021.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: There are limited data to identify the best care model to support the vulnerable adolescent and young adult (AYA) oncology population. We sought to compare the impact of AYA physician visits versus interdisciplinary team (IDT) care on AYA-specific resource identification and utilization, as well as to provide a model of AYA oncology care implementation. Methods: We identified AYA-aged patients 15-39 years with a current or prior history of cancer seen by the University of Wisconsin Carbone Cancer Center (UWCCC) AYA Oncology Program between January 21, 2021 and May 27, 2021. Patients in this program have a one-on-one clinic visit with an AYA oncologist followed 4 days later by presentation at an AYA IDT meeting. We conducted retrospective chart review to quantify AYA-specific resource utilization before the AYA program visit, as well as novel resources identified by the AYA physician visit and the IDT meeting, and conducted a descriptive statistical analysis of the data. Results: We identified 35 patients seen by the UWCCC AYA Oncology Program. Before their AYA clinic visit, patients used an average of 2.51 AYA-specific services. An average of 4.45 novel resources was identified by the AYA Oncology Program per patient. This included an average of 2.54 and 1.91 additional resources identified per patient through the AYA physician visit and IDT meeting, respectively. The most common resource needs identified overall fell into the "other" category, consisting of a wide variety of resource domains (26/35) and peer support (27/35). Conclusions: Our data support increased resource identification through an AYA-specific care model. These objective data support the critical importance of AYA interdisciplinary care, as well as the use of an AYA IDT meeting model as a method to include interdisciplinary care in AYA programs despite possible resource constraints.
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Affiliation(s)
- Leah J Gruen
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cathy A Lee-Miller
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Fauzia Osman
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Amanda Parkes
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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27
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Cable M, Watts T, Reagon C, Kelly D. Experiences of early‐career nurses working in specialist adolescent/young adult cancer units: A narrative inquiry. J Adv Nurs 2022. [DOI: 10.1111/jan.15488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Maria Cable
- School of Healthcare Sciences Cardiff University Cardiff UK
| | - Tessa Watts
- School of Healthcare Sciences Cardiff University Cardiff UK
| | - Carly Reagon
- School of Healthcare Sciences Cardiff University Cardiff UK
| | - Daniel Kelly
- School of Healthcare Sciences Cardiff University Cardiff UK
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28
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Moraitis AM, Seven M, Sirard J, Walker RR. Clinical Relevance and Implementation Considerations of Physical Activity in Young Adult Cancer Survivorship: An Expert Consensus Study. J Adolesc Young Adult Oncol 2022. [PMID: 36269579 DOI: 10.1089/jayao.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Elevated survival rates in young adult cancer survivors (YACS) are accompanied by high morbidity levels resulting in an array of unmet needs limiting full life potential. Physical activity (PA) improves physical, psychological, and social aspects of health after a cancer diagnosis. There are no standardized PA guidelines tailored to YACS. Therefore, there is a critical need to understand areas of clinical relevance/agreement on PA use and implementation in young adult (YA) survivorship care. Aim: To identify expert consensus areas on the assessment, prescription, and implementation of PA in YA survivorship care; identify areas of clinical relevance and endorsement of PA as a health optimization strategy in YA survivorship care. Methods: A four-round modified Delphi study of international multidisciplinary experts (Round I/II n = 18; Round III n = 57, Round IV n = 45) in exercise oncology, symptom management, survivorship care, youth cancer care was conducted. Qualitative content analysis, descriptive statistics (% agreement, standard deviation, mean), and inter-rater reliability (Kappa) were calculated. Results: Experts reached a consensus on clinical providers needed to assess, refer, and provide PA interventions, the need for guidelines, and essential care delivery system components to foster the integration of PA integration in YA survivorship care as a health optimization activity. Conclusions/Implications: Cancer care integration models should optimize the unique preferences, strengths, and developmental stage of YA affected by cancer. The study adds to the existing literature on multidisciplinary teams needed to provide clinical expertise and organizational support to foster PA integration into YA survivorship care.
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Affiliation(s)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - John Sirard
- Department of Kinesiology and Commonwealth Honors College, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - Rachel Rae Walker
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
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29
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Oswald LB, Fox RS, Murphy KM, Salsman JM, Sanford SD, McDade TW, Victorson DE. Preliminary Effects of Mindfulness Training on Inflammatory Markers and Blood Pressure in Young Adult Survivors of Cancer: Secondary Analysis of a Pilot Randomized Controlled Trial. Int J Behav Med 2022; 29:676-684. [PMID: 35048316 PMCID: PMC9296689 DOI: 10.1007/s12529-021-10050-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND This was a secondary analysis of a pilot randomized controlled trial (RCT) of mindfulness-based stress reduction (MBSR) among young adult (YA) survivors of cancer, which showed preliminary evidence for improving psychosocial outcomes. Secondary outcomes assessed were the feasibility of collecting biological data from YAs and preliminary effects of MBSR on markers of inflammation and cardiovascular function. METHOD Participants were randomized to 8-week MBSR or a waitlist control condition. Participants provided whole blood spot samples for analysis of C-reactive protein (CRP) and interleukin (IL)-6 as well as blood pressure data in-person at baseline and 16-week follow-up. Feasibility was assessed with rates of providing biological data. Linear mixed effects modeling was used to evaluate preliminary effects of MBSR on inflammatory markers and blood pressure over time. RESULTS Of 126 total participants enrolled, 77% provided biological data at baseline (n = 48/67 MBSR, n = 49/59 control). At 16 weeks, 97% of the 76 retained participants provided follow-up biological data (n = 34/35 MBSR, n = 40/41 control). Relative to the control group, MBSR was associated with decreased systolic blood pressure (p = 0.042, effect sizes (ES) = 0.45) and decreased diastolic blood pressure (p = 0.017, ES = 0.64). There were no changes in CRP or IL-6. CONCLUSION This was the first study to explore the feasibility of collecting biological data from YA survivors of cancer and assess preliminary effects of MBSR on inflammatory and cardiovascular markers in an RCT. Minimally invasive biological data collection methods were feasible. Results provide preliminary evidence for the role of MBSR in improving cardiovascular outcomes in this population, and results should be replicated.
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Affiliation(s)
- Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
| | - Karly M Murphy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacy D Sanford
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
| | - Thomas W McDade
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - David E Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 2205 Tech Drive, Suite 2-120, Evanston, Chicago, IL, USA.
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30
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Ziegler E, Nickel S, Trojan A, Klein J, Kofahl C. Self-help friendliness in cancer care: A cross-sectional study among self-help group leaders in Germany. Health Expect 2022; 25:3005-3016. [PMID: 36129136 DOI: 10.1111/hex.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peer support is increasingly recognized as crucial for improving health and psychosocial outcomes in oncological care. The integration of cancer self-help groups (SHGs) into cancer care facilities has gained importance in recent years. Yet, there is a lack of knowledge of the extent and quality of cooperation between cancer care facilities and SHGs and their integration into routine care. The concept of self-help friendliness (SHF) provides a feasible instrument for the measurement of cooperation and integration. METHODS A cross-sectional study across Germany investigates the experiences of 266 leaders of cancer SHGs concerning their cooperation with cancer care facilities based on the criteria for SHF. The participatory study was developed and conducted with representatives of the House of Cancer Self-Help and the federal associations of cancer self-help. RESULTS According to the SHG leaders, about 80% of their members primarily find their way to an SHG via other patients and only less than 50% more or less frequently via hospitals or rehabilitation clinics. The quality of cooperation with cancer centres, hospitals and rehabilitation clinics, however, is rated as good to very good by more than 70% of the respondents. Nine out of 10 quality criteria for SHF are fully or at least partially implemented, the values vary between 53% and 87%. Overall, 58% of the SHG leaders feel well to be very well integrated into care facilities. CONCLUSIONS The results show a positive assessment of the involvement of SHGs in oncological care, but differences between inpatient and outpatient care and low referrals to SHGs are prominent. The concept of SHF is a feasible solution for a systematic and measurable involvement of SHGs. PATIENT OR PUBLIC CONTRIBUTION The perspectives and insight of patient representatives obtained through qualitative interviews were directly incorporated into this study. Representatives of cancer self-help organizations were involved in the development of the questionnaire, reviewed it for content and comprehensibility, and further helped to recruit participants.
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Affiliation(s)
- Elâ Ziegler
- Centre for Psychosocial Medicine, Institute of Medical Sociology, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Nickel
- Centre for Psychosocial Medicine, Institute of Medical Sociology, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alf Trojan
- Centre for Psychosocial Medicine, Institute of Medical Sociology, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Centre for Psychosocial Medicine, Institute of Medical Sociology, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Centre for Psychosocial Medicine, Institute of Medical Sociology, Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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31
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Kerba J, Demers C, Bélanger V, Napartuk M, Bouchard I, Meloche C, Morel S, Prud’homme N, Gélinas I, Higgins J, Curnier D, Sultan S, Laverdière C, Sinnett D, Marcil V. Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents’ Perspective. CHILDREN 2022; 9:children9091340. [PMID: 36138649 PMCID: PMC9497682 DOI: 10.3390/children9091340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
Treatments for adolescent cancer can cause debilitating side effects in the short- and long-term such as nausea and malnutrition but also cardiometabolic disturbances. Although the risk for cardiometabolic complications is greater for adolescents with cancer than younger ones, adolescents typically respond poorly to family-oriented health promotion programs. This study aims to assess the needs, barriers and facilitators to healthy lifestyle promotion interventions for adolescents with cancer and how to best adapt these interventions for them. Interviews were held with adolescents treated for cancer (n = 9) and parents (n = 6), focus groups were conducted with stakeholders working in oncology (n = 12) and self-report questionnaires were sent to stakeholders involved in a health promotion intervention (n = 6). At the time of interview, mean age of adolescent participants (40% female) was 17.0 ± 1.9 years (mean age at diagnosis: 14.6 ± 1.6 years). Verbatim and responses to questionnaires were coded and analyzed using qualitative methods. Stakeholder stated that adolescents with cancer need to access activities adapted to their age, to communicate with peers going through a similar experience, and to preserve their schooling and friendships. Barriers to intervention reported by adolescents, parents and stakeholders include lack of motivation, schedule conflicts, fatigue and treatment side effects. Some of the barriers mentioned by adolescents and parents include pain, post-surgery problems, school, physical deconditioning, and lack of time. Facilitators mentioned by adolescents and parents comprise trust in stakeholders’ expertise, personalized approaches, scheduling flexibility. Stakeholders recommended to build trust in the relationship, favoring non-moralizing teachings, adapt interventions to adolescents’ limited attention span and avoiding the use of long-term health benefits as a motivator.
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Affiliation(s)
- Johanne Kerba
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
| | - Catherine Demers
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
| | - Véronique Bélanger
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
| | - Mélanie Napartuk
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
| | - Isabelle Bouchard
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Caroline Meloche
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Sophia Morel
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
| | - Nicolas Prud’homme
- Division of Hematology-Oncology, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - Isabelle Gélinas
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montreal, QC H3N 1X7, Canada
| | - Daniel Curnier
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Serge Sultan
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Caroline Laverdière
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Daniel Sinnett
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada
| | - Valérie Marcil
- Research Center of the CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada
- Department of Nutrition, Université de Montreal, Montreal, QC H3T 1A8, Canada
- Cardiometabolic Health, Diabetes, and Obesity Research Network (CMDO), Montreal, QC J1H 5N4, Canada
- Institute of Nutrition and Functional Food, Quebec City, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-514-345-4931-(3272)
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Haines E, Asad S, Lux L, Gan H, Noskoff K, Kumar B, Roggenkamp B, Salsman JM, Birken S. Guidance to Support the Implementation of Specialized Adolescent and Young Adult Cancer Care: A Qualitative Analysis of Cancer Programs. JCO Oncol Pract 2022; 18:e1513-e1521. [PMID: 35749679 PMCID: PMC9509058 DOI: 10.1200/op.22.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/06/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The nearly 90,000 adolescents and young adults (AYAs) diagnosed with cancer in the United States yearly have tended to occupy a no-man's land between medical and pediatric oncology, often reporting that existing models of care are misaligned with their needs and preferences. Although guidelines for optimal AYA cancer care are increasingly available, the implementation of such standards has been varied. This may be in part due to a lack of guidance for implementing specialized AYA care. In this study, we leveraged an implementation science framework to identify barriers and generate practical guidance to inform the implementation of specialized AYA cancer care. METHODS We conducted semistructured qualitative interviews, guided by the Consolidated Framework for Implementation Research, with AYA care stakeholders (N = 32 from 14 cancer programs). Our multidisciplinary research team analyzed interview transcriptions using a template analysis approach and gleaned from interviews practical guidance for implementing specialized AYA care. RESULTS Participants reported barriers to implementing specialized AYA care across all five Consolidated Framework for Implementation Research domains: (1) intervention characteristics (eg, costs), (2) inner setting (eg, difficulties in collaborating between pediatric and medical oncology), (3) outer setting (eg, patient-level barriers to participating in AYA services), (4) individual characteristics (eg, attitudes about AYA oncology), and (5) process (eg, lack of metrics for program evaluation). They also shared practical guidance for addressing these barriers. CONCLUSION Emerging guidance on the core elements of AYA cancer care must be matched with guidance to support the implementation of specialized AYA care. This study contributes to the body of evidence available to inform future implementation efforts.
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Affiliation(s)
- Emily Haines
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah Asad
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lauren Lux
- Comprehensive Cancer Support Program, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC
| | | | | | | | | | - John M. Salsman
- Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
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Hess E, Anandan A, Osman F, Lee-Miller C, Parkes A. Disparities in Treatment Satisfaction and Supportive Care Receipt for Young Adult Oncology Patients on the Basis of Residential Location. JCO Oncol Pract 2022; 18:e1542-e1552. [DOI: 10.1200/op.21.00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Adolescent and young adult oncology programs are critical but exist primarily in academic centers, prompting potential disparities in care on the basis of patient residence. We studied the impact of residential location on supportive care receipt and treatment satisfaction in young adults (YAs) with cancer age 19-39 years treated at the University of Wisconsin Carbone Cancer Center (UWCCC). METHODS: YA patients with cancer age 19-39 years seen at UWCCC from March 30, 2019, to March 29, 2020, were sent a survey assessing supportive care receipt and satisfaction. Survey results were compared with retrospective chart review of YAs seen at UWCCC between April 1, 2011, and April 1, 2021. Data were categorized on the basis of residential location using distance from UWCCC and 2013 Rural-Urban Continuum Code (RUCC). RESULTS: Survey results were obtained for 145 YAs, including 29 from nonmetro RUCC (20.0%) and 81 living > 20 miles from UWCCC (55.9%). YAs from nonmetro locations had lower satisfaction with available treatments (79.3% v 91.4%, P = .005), and distant YAs living > 20 miles from UWCCC more frequently identified location as a barrier to supportive care receipt (35.6% v 15.8%, P = .02). Metro YAs more frequently listed fertility consultations as unavailable (38.0% v 16.0%, P = .04) in the survey despite chart review data showing higher rates of sexual health assessments (48.2% v 20.4%, P = .002) and fertility visits (29.6% v 18.5%, P = .18). CONCLUSION: We identified differences in both supportive care receipt and treatment satisfaction on the basis of residential location. These findings support the need for measures to successfully meet treatment and supportive care needs regardless of residential location.
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Affiliation(s)
- Eric Hess
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Apoorva Anandan
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Fauzia Osman
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Cathy Lee-Miller
- University of Wisconsin-Madison School of Medicine and Public Health Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Madison, WI
| | - Amanda Parkes
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
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Park M, Kwon SY, Yun H, Lyu CJ, Han JW, Hahn SM, Jung M, Rha SY, Beom SH, Lee CK, Jang H. Care Needs of Adolescents and Young Adults with Cancer Undergoing Active Treatment in South Korea: A Mixed Methods Study. J Adolesc Young Adult Oncol 2022. [PMID: 35904961 DOI: 10.1089/jayao.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer have special care needs that are different from those of children and older adults with cancer. This study assessed the perspective and experience of AYAs with cancer in South Korea to identify their care needs. Methods: This study used a convergent mixed-methods design. From July 2020 to November 2021, AYAs with cancer (N = 77; 15-39 years of age) participated in a quantitative cross-sectional study, using a tool developed by our study team. In May 2021, a qualitative focus group was conducted with 10 AYAs with cancer. Integrated analyses were conducted concurrently by reporting the quantitative and qualitative findings together. Results: Quantitative findings revealed that the highest care need domains were communication and information, whereas the highest care priority item was the management of pain and symptoms occurring during the treatment. Qualitative findings revealed 12 themes across 5 domains. Comparing and merging of the quantitative and qualitative data resulted in eight confirmed themes and four expanded findings, including knowing people who overcame similar illnesses, fear of death, dedicated space, and a program for AYAs with cancer. Conclusion: When developing and implementing programs and health care services, especially in countries with no established program or cancer specialty unit for AYAs with cancer, it is important to consider the special care needs and priorities of AYAs with cancer. This mixed methods study provided empirical evidence to help understand and prioritize the needs of AYAs with cancer undergoing active treatment in South Korea.
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Affiliation(s)
- Mina Park
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Nursing, Yonsei University Graduate School, Seoul, South Korea
| | - Seung Yeon Kwon
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Hyeseon Yun
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea
| | - Chuhl Joo Lyu
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Woo Han
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Min Hahn
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea.,Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Minkyu Jung
- Department of Nursing, Yonsei University Graduate School, Seoul, South Korea.,Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Hoon Beom
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyeju Jang
- Provider Partners Health Plan, Linthicum Heights, Maryland, USA
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Srikanthan A, Karpinski J, Gupta A. Adolescent and young adult (AYA) oncology: A credentialed area of focused competence in Canada. Cancer Med 2022; 12:1721-1728. [PMID: 35822349 PMCID: PMC9883556 DOI: 10.1002/cam4.5024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/14/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYA, ages 15-39 years) affected by cancer have unique treatment, survivorship, and palliation concerns. Current oncology training does not focus on the distinctive needs of this demographic. Amid this recognition, the Canadian National AYA Cancer Task Force and Canadian Partnership Against Cancer have advocated the need for clinicians with formalized AYA experience. To address this need and standardize training, a national task force developed criteria for structured academic programs in AYA Oncology in Canada. METHODS Workshops were organized to identify and establish the fundamentals of practice in AYA Oncology through consensus. These workshops followed the pre-existing rigorous process established by the Royal College of Physicians and Surgeons of Canada (Royal College) for new program development. The process includes: (i) developing the tasks associated with the discipline's practice, (ii) identifying the evidence trainees must provide to demonstrate tasks can be performed independently (the competence portfolio), (iii) developing training requirements and summarizing the knowledge, skills and attitudes required to perform these tasks, and (iv) identifying specific experiences essential to acquiring skills and demonstrating competent performance. RESULTS AYA Oncology is a recognized an Area of Focused Competence (AFC) by the Royal College. CONCLUSION The AFC designation in AYA Oncology provides a standardized curriculum, training experience and accreditation process to attract oncologists, promote expertise and advance AYA oncology care.
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Affiliation(s)
- Amirrtha Srikanthan
- Division of Medical OncologyDepartment of MedicineUniversity of OttawaOttawaOntarioCanada,Division of Medical OncologyThe Ottawa Hospital Cancer CentreOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Jolanta Karpinski
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada,Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Abha Gupta
- Princess Margaret Cancer CentreThe Hospital for Sick KidsTorontoOntarioCanada
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36
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Sansom-Daly UM, Wiener L, Darlington AS, Poort H, Rosenberg AR, Weaver MS, Schulte F, Anazodo A, Phillips C, Sue L, Herbert AR, Mack JW, Lindsay T, Evans H, Wakefield CE. Thinking globally to improve care locally: A Delphi study protocol to achieve international clinical consensus on best-practice end-of-life communication with adolescents and young adults with cancer. PLoS One 2022; 17:e0270797. [PMID: 35802558 PMCID: PMC9269432 DOI: 10.1371/journal.pone.0270797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
For the sizeable subset of adolescents and young adults whose cancer is incurable, developmentally appropriate end-of-life discussions are critical. Standards of care for adolescent and young adult end-of-life communication have been established, however, many health-professionals do not feel confident leading these conversations, leaving gaps in the implementation of best-practice end-of-life communication. We present a protocol for a Delphi study informing the development and implementation of clinician training to strengthen health-professionals’ capacity in end-of-life conversations. Our approach will inform training to address barriers to end-of-life communication with adolescents and young adults across Westernized Adolescent and Young Adult Cancer Global Accord countries. The Adolescent and Young Adult Cancer Global Accord team involves 26 investigators from Australia, New Zealand, the United States, Canada and the United Kingdom. Twenty-four consumers, including adolescents and young adults with cancer history and carers, informed study design. We describe methodology for a modified Delphi questionnaire. The questionnaire aims to determine optimal timing for end-of-life communication with adolescents and young adults, practice-related content needed in clinician training for end-of-life communication with adolescents and young adults, and desireability of evidence-based training models. Round 1 involves an expert panel of investigators identifying appropriate questionnaire items. Rounds 2 and 3 involve questionnaires of international multidisciplinary health-professionals, followed by further input by adolescents and young adults. A second stage of research will design health-professional training to support best-practice end-of-life communication. The outcomes of this iterative and participatory research will directly inform the implementation of best-practice end-of-life communication across Adolescent and Young Adult Cancer Global Accord countries. Barriers and training preferences identified will directly contribute to developing clinician-training resources. Our results will provide a framework to support further investigating end-of-life communication with adolescents and young adults across diverse countries. Our experiences also highlight effective methodology in undertaking highly collaborative global research.
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Affiliation(s)
- Ursula M. Sansom-Daly
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Youth Cancer Service, Prince of Wales/Sydney Children’s Hospital, Randwick, New South Wales, Australia
- * E-mail:
| | - Lori Wiener
- Psychosocial Support and Research Program, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Anne-Sophie Darlington
- School of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom
| | - Hanneke Poort
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Abby R. Rosenberg
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Meaghann S. Weaver
- Divisions of Palliative Care & Pediatric Hematology/Oncology, University of Nebraska Medical Center, Lincoln, Nebraska, United States of America
- National Center for Ethics in Health Care, Washington DC, Washington, United States of America
| | - Fiona Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hematology, Oncology and Transplant Program, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Antoinette Anazodo
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
- Sydney Youth Cancer Service, Prince of Wales/Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - Celeste Phillips
- School of Nursing, Indiana University, Indianapolis, Indiana, United States of America
| | - Louise Sue
- Adolescent and Young Adult Cancer Services Team, Canterbury District Health Board, Christchurch, New Zealand
| | - Anthony R. Herbert
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Centre for Children’s Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jennifer W. Mack
- Population Sciences for Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Toni Lindsay
- Chris O’Brien Lifehouse Cancer Centre, Camperdown, New South Wales, Australia
| | - Holly Evans
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia
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Berger I, Krishnasamy M, Thompson K, Celeste T, Joubert L. Service Needs of Parent Caregivers of Adolescents and Young Adults with Incurable Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2022; 12:133-146. [PMID: 35787154 DOI: 10.1089/jayao.2022.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adolescent and Young Adult (AYA) oncology is an internationally recognized established subspecialty in cancer care. Dedicated programs tailored to local environments endeavor to address unique medical, psychological, cognitive, and social needs that historically, health services have been challenged to meet. In recent years there has been a growing appreciation of the challenges facing AYA with incurable cancer and their parent caregivers. While health care professionals recognize the importance of parents' involvement in the care trajectory, there is less understanding of the services needed for support. This scoping review set out to identify and describe evidence available to better understand the services and approaches required from hospital teams to address the needs of parent caregivers and to identify gaps in knowledge to inform areas for further research. The question guiding this review is: What are the service needs of parent carers of AYA with incurable cancer. Using the Arksey and O'Malley scoping review framework, 1009 studies were identified from a broad search of relevant online databases, gray literature, and reference lists of published studies. After removing duplicates and ineligible studies, 492 abstracts were screened. Of these, 421 were ineligible, and 71 articles underwent full-text review. Eight studies were included in the final review. No single study was focused exclusively on parent caregivers of AYA with incurable cancer, demonstrating a paucity of quantitative and qualitative evidence to inform practice and a need for further research in the field.
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Affiliation(s)
- Ilana Berger
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Center, Melbourne, Australia.,School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia.,Academic Nursing Unit, Peter MacCallum Cancer Center, Melbourne, Australia.,Research and Education Lead-Nursing, Victorian Comprehensive Cancer Center Alliance, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Center, Melbourne, Australia.,School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Tania Celeste
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- School of Health Sciences, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Australia
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Patterson P, McDonald FEJ, Allison KR, Bibby H, Osborn M, Matthews K, Sansom-Daly UM, Thompson K, Plaster M, Anazodo A. The Clinical Utility of the Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST): Perspectives of AYA Cancer Patients and Healthcare Professionals. Front Psychol 2022; 13:872830. [PMID: 35602702 PMCID: PMC9120841 DOI: 10.3389/fpsyg.2022.872830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Routine psychosocial screening and assessment of people diagnosed with cancer are crucial to the timely detection of distress and provision of tailored supportive care; however, appropriate screening tools have been lacking for adolescents and young adults (AYAs), who have unique needs and experiences. One exception is the recently validated AYA Psycho-Oncology Screening Tool (AYA-POST) for use with young people aged 15–29 years, which comprises a distress thermometer and age-specific needs assessment. This study investigates the clinical utility of this measure, as well as the subsequent service responsiveness within the Australian Youth Cancer Services. Method In total, 118 AYAs and 29 healthcare professionals: (HCPs) completed surveys about the clinical utility of the AYA-POST; a subset of 30 AYAs completed a 3-month follow-up survey assessing service responsiveness. Descriptive statistics (frequencies/means) were computed for all items, with chi-square analyses used to explore whether perceived clinical utility varied with AYA age, AYA sex, HCP discipline or HCP length of time using the AYA-POST. Results Participants’ responses demonstrate high levels of satisfaction with the tool, evidencing its appropriateness, practicability and acceptability. Moreover, the AYA-POST was reported to facilitate communication about psychosocial needs and prompt referrals, indicating good service responsiveness. Ratings of clinical utility did not differ significantly between AYA and HCP groups. Conclusion This study demonstrates that the AYA-POST is an appropriate tool in the psychosocial screening of AYAs with cancer, facilitating the identification of distress and unique concerns in this population and valuable in triaging and tailoring care for young cancer patients.
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Affiliation(s)
- Pandora Patterson
- Canteen Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Pandora Patterson,
| | - Fiona E. J. McDonald
- Canteen Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Michael Osborn
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Matthews
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
| | - Ursula M. Sansom-Daly
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
- Behavioural Sciences Unit, School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Kate Thompson
- Victoria/Tasmania Youth Cancer Service, Melbourne, VIC, Australia
| | - Meg Plaster
- Western Australia Youth Cancer Service, Perth, WA, Australia
| | - Antoinette Anazodo
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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39
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McGrady ME, Mara CA, Beal SJ, Chan SF, Sorge CE, Pai ALH. Development and Preliminary Validation of a Multidimensional Psychosocial Assessment Strategy for Young Adults With Cancer. J Pediatr Psychol 2022; 47:952-963. [PMID: 35380687 DOI: 10.1093/jpepsy/jsac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Regular psychosocial assessment is a best-practice guideline for young adult oncology care, but multipurpose, multidimensional, developmentally appropriate patient-reported outcome measurement strategies for young adults with cancer are lacking. This study reported on the development and preliminary validation of the Young Adult Psychosocial Assessment Strategy (YA-PAS), a tool designed to meet this clinical need. METHODS The YA-PAS was developed based on the literature and clinician feedback. 20 young adults with cancer participated in cognitive interviews to provide feedback on complexity, readability, and applicability to inform measure refinement. Following refinements, 100 young adults with a history of cancer participated in an observational study including a preliminary evaluation of YA-PAS factor structure, internal consistency, test-retest reliability, construct and criterion validity, feasibility, and acceptability. RESULTS Cognitive interviews and psychometric evaluation informed modifications and resulted in a measure with 9 domains (anxiety, depression, cognitive functioning, post-traumatic stress, family stressors, support, social isolation, self-efficacy for symptom management, and self-efficacy for medication management) and nonscoring items assessing substance use, life stressors, resources, educational/vocational status, and relationship status. 8 of 9 domains demonstrated acceptable internal consistency (Cronbach's α ≥ 0.70), substantial (r = 0.61-0.80) or almost perfect (r > 0.80) test-retest reliability, and evidence of domain and cut-point validity. 89% of participants were able to complete the YA-PAS within 20 min and 87% were satisfied with the measure. CONCLUSIONS The YA-PAS demonstrated promising psychometric properties, feasibility, and acceptability. Clinical implications and research recommendations are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Constance A Mara
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Sarah J Beal
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Sherilynn F Chan
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Caryn E Sorge
- Department of Pediatrics, Division of Hematology Oncology, University of Kentucky, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
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40
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Broholm-Jørgensen M, Tjørnhøj-Thomsen T, Pedersen PV. Development of an intervention for the social reintegration of adolescents and young adults affected by cancer. BMC Public Health 2022; 22:241. [PMID: 35123447 PMCID: PMC8818212 DOI: 10.1186/s12889-022-12611-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Background In Denmark, around 500 adolescents and young adults (AYAs) aged 15–29 are diagnosed with cancer each year. AYAs affected by cancer constitute a vulnerable group in need of special support in pursuing everyday life as young people. These needs are, however, not currently being adequately met. This study explores the distinctive needs of AYAs aged 15–25 and affected by cancer with the aim of developing and designing an intervention that accommodates these needs and allows AYAs to pursue everyday life following active cancer treatment. Methods We combined multiple qualitative methods to conduct six sub-studies: 1) participant observation among support groups for AYAs affected by cancer, 2) field visit at a large Danish hospital, 3) qualitative interviews with AYAs currently or previously diagnosed with cancer, 4) qualitative interviews with practitioners working with young cancer patients or AYAs with chronic conditions, 5) an interactive workshop with practitioners, and 6) an interactive workshop with AYAs. The empirical material was collected between May 2016 and April 2019. The empirical material was read, analysed thematically and coded into the themes; 1) diagnosis and treatment, 2) form of education and 3) age, financial challenges and legal entitlements. Results Across the empirical material, we found that AYAs’ cancer experience was heterogeneous. The needs of AYAs differed according to 1) diagnosis and treatment, 2) type of education and 3) age, financial situation and legal entitlements. The findings demonstrate a need for a tailored intervention accommodating the variety of opportunities, requirements and challenges of AYAs with cancer. We propose an intervention consisting of a multidisciplinary team sited at the hospital where the individual AYA receives treatment. The team’s main task will be to maintain AYAs’ social competences and ease their return to everyday life after serious illness by balancing educational requirements with cancer treatment. Conclusion Based on the perspectives of practitioners and AYAs affected by cancer, this study outlines an intervention designed as a care pathway in which a multidisciplinary team provides individual and tailored support to AYAs with cancer from the time of diagnosis during and beyond active cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12611-4.
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Psychosocial Needs and Preferences for Care among Adolescent and Young Adult Cancer Patients (Ages 15–39): A Qualitative Study. Cancers (Basel) 2022; 14:cancers14030710. [PMID: 35158975 PMCID: PMC8833451 DOI: 10.3390/cancers14030710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022] Open
Abstract
Simple Summary Adolescents and young adults (AYAs) are a unique population: they are a diverse group between the ages of 15–39 years with distinct needs and experience numerous developmental milestones during this age range. Notably, AYAs have faced worse outcomes in cancer care, both with shorter survival and worse quality of life compared to children and older adults. Understanding AYAs’ psychosocial, communication and informational needs is crucial to addressing this disparity and improving cancer care delivery. By hearing directly from AYAs, we are able to capture nuances of their experiences and provide clinical recommendations to healthcare providers involved in the care of AYAs with cancer. This study specifically interviewed AYAs with cancer to understand their perspectives, identify needs and to develop recommendations for cancer care delivery and accommodations across the cancer experience. Abstract Adolescents and young adults (AYAs) require a multidisciplinary approach to cancer care due to their complex biopsychosocial situations and varied developmental maturity. Currently, age and diagnosis determine referral to pediatric or adult oncology, with differing treatment paradigms and service utilization patterns, contributing to suboptimal improvements in outcomes. Understanding the unique perspectives of AYAs is essential to designing patient-centered AYA services. Thus, we conducted six focus groups with AYAs (n = 25) treated by medical or pediatric oncologists to evaluate: (1) the unique experiences of cancer care as an AYA; (2) AYA-specific information needs and communication preferences; and (3) recommendations for service provision, delivery and accommodations for AYAs. Transcripts were analyzed using inductive thematic content analysis and identified six major themes to inform clinically-actionable recommendations and the development of a patient-reported outcome measure: (1) AYAs experience social isolation and loss of independence; (2) AYAs have an uncertain sense of the future and need conversations around survivorship and long-term and late effects; (3) AYAs desire greater control over discussions with their care team; (4) AYAs need additional navigational and social/caregiver supports; (5) AYAs prefer an inclusive AYA space in the hospital; and (6) LGBTQ+ patients experience distinct concerns as AYA cancer patients. These will form the basis for specific and tailored clinical recommendations to improve AYA cancer care delivery.
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Ishiki H, Hirayama T, Horiguchi S, Iida I, Kurimoto T, Asanabe M, Nakajima M, Sugisawa A, Mori A, Kojima Y, Udagawa R, Tsuchiya H, Oki M, Shimizu M, Yanai Y, Touma S, Nozawa K, Kojima R, Inamura N, Maehara A, Suzuki T, Satomi E. A Support System for Adolescent and Young Adult Patients with Cancer at a Comprehensive Cancer Center. JMA J 2022; 5:44-54. [PMID: 35224259 PMCID: PMC8827278 DOI: 10.31662/jmaj.2021-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
Cancer patients in adolescents and young adults (AYA) generation aged 15-39 years have various psychosocial needs during their treatment course such as school enrollment, finding employment, marriage, and fertility. It is difficult for medical professionals to gain experience related to providing medical care and consultation support to these kinds of AYA generation cancer patients. There is a need to provide information and establish both support and medical care systems that are able to meet the diverse needs unique to this generation. This review will explain how to launch an AYA support team (AST). We have worked and established the AST since 2016, which is medical care teams that provide support according to the life stage of each individual patient and build a multidisciplinary AYA generation patient support system. The team-building process consisted of two main projects: building and enlarging multidisciplinary team and establishing screening process of psychosocial needs of AYA generation patients. Multidisciplinary healthcare professionals got involved in the AST with already-existing patient support functions in our center: the patient support center, which is an outpatient department and the palliative care team, which is an inpatient interdepartmental team. The AST systematically finds patients in need of assistance and offers them support as a multidisciplinary team. The AST also established a procedure that systematically gathers information about the needs of patients by using a screening tool. In addition, the AST provides the following specialized services: reproductive medicine, supporting cancer patients with children, employment support, and peer support. The AST has been established and sophisticatedly worked. It can flexibly provide various psychosocial support services. This review will explain how to launch an AST.
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Affiliation(s)
- Hiroto Ishiki
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Saki Horiguchi
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Ikumi Iida
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Tamae Kurimoto
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Mihoko Asanabe
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Miho Nakajima
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akiko Sugisawa
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Ayako Mori
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Kojima
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ryoko Udagawa
- Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Hayato Tsuchiya
- Nutrition Management Office, National Cancer Center Hospital, Tokyo, Japan
| | - Mami Oki
- Department of Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Mariko Shimizu
- Center for Physician Referral and Medical Social Service, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Yanai
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shoko Touma
- Appearance Support Center, National Cancer Center Hospital, Tokyo, Japan
| | - Keiko Nozawa
- Appearance Support Center, National Cancer Center Hospital, Tokyo, Japan
| | - Rebekah Kojima
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Naoko Inamura
- Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Asami Maehara
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.,Department of Nursing, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.,Center for Physician Referral and Medical Social Service, National Cancer Center Hospital, Tokyo, Japan
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Pitch N, Stefaniuk S, MacMillan M, Catsburg J, Gupta AA, Vora T. Looking Back to Move Forward: Lessons Learned from a Successful, Sustainable, Replicable Model of Adolescent and Young Adult Program of a Tertiary Cancer Care Center. J Adolesc Young Adult Oncol 2022; 11:181-188. [PMID: 35007440 PMCID: PMC9057888 DOI: 10.1089/jayao.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The Princess Margaret Cancer Centre (PM) established the adolescent and young adult (AYA) oncology program in 2014 to address the unique needs of AYA by delivering targeted, evidence-based care through a multidisciplinary team. Methods: We performed a retrospective analysis of patients who underwent a consultation with the PM AYA program from 2014 to 2020. The association between the health domain concerns reported and age at consultation, cancer diagnoses, and time since diagnosis was analyzed using chi-square test of independence in SPSS. Results: In our cohort of 1128 AYA, the median age at assessment was 28.2 years. The most common diagnoses were lymphoma (n = 251, 22.2%), leukemia (n = 207, 18.4%), and breast cancer (n = 162, 14.4%). The most common concerns reported were related to fertility (n = 882, 78.2%) and work/school (n = 472, 41.8%). Fertility concerns were most common in 25–34 age group (443/540, 82.0%) and work-/school-related concerns were highest in 18–24 age group (191/355, 53.8%). Diagnoses significantly affect majority of concerns reported. Fertility concerns were most common in AYA consulted near diagnosis, while body image-, exercise-, and diet-related concerns were more frequently reported, while on active treatments. Conclusions: Supporting fertility concerns remains the cornerstone of any successful AYA program. Work-/school-related concerns deserve more elucidation and attention. We identified important patterns in the health-related concerns of AYA, especially as they relate to age, diagnoses, and time since diagnosis. This insight will guide us for improving patient-centered care delivery to AYA.
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Affiliation(s)
- Natalie Pitch
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Stephanie Stefaniuk
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Meghan MacMillan
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Alberta Health Services, Edmonton, Canada
| | - Jennifer Catsburg
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Abha A Gupta
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Tushar Vora
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Saab R. Burden of cancer in adolescents and young adults. Lancet Oncol 2021; 23:2-3. [PMID: 34871552 DOI: 10.1016/s1470-2045(21)00649-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Raya Saab
- Children's Cancer Institute, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Husson O, Reeve BB, Darlington AS, Cheung CK, Sodergren S, van der Graaf WTA, Salsman JM. Next Step for Global Adolescent and Young Adult Oncology: A Core Patient-Centered Outcome Set. J Natl Cancer Inst 2021; 114:496-502. [PMID: 34865066 DOI: 10.1093/jnci/djab217] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
The relatively small number of cancers in the adolescent and young adult (AYA) age group, those aged 15-39 years, does not appropriately reflect the personal and societal costs of cancer in this population, as reflected in the potential years of life lost or saved; the decreased productivity and health-related quality of life due to the impact of the disease during formative years and long-term complications or disabilities. Improvements in care and outcomes for AYAs with cancer require collaboration among different stakeholders at different levels (patients, caregivers, healthcare professionals, researchers, industry, and policymakers). Development of a Core Outcome Set (COS), an agreed minimum set of outcomes that should be measured globally in research, routine clinical practice, specifically for AYAs with cancer, with outcomes that are well defined based on the perspective of those who are affected and assessed with validated measures is highly required. A globally implemented COS for AYAs with cancer will facilitate better pooling of research data and the implementation of high-quality healthcare registries, which by benchmarking not only nationally, but also internationally, may ultimately improve the value of the care given to these underserved young cancer patients. We reflect on the need to develop a COS for AYA with cancer, the arenas of application and the challenges of implementing an age-specific COS in research and clinical practice.
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Affiliation(s)
- Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Clinical Studies; Institute of Cancer Research, London, UK.,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bryce B Reeve
- Department of Population Health Sciences; Duke University School of Medicine; Durham, NC, USA
| | | | | | | | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology; Erasmus MC Cancer Institute; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John M Salsman
- Department of Social Sciences & Health Policy; Wake Forest School of Medicine; Wake Forest Baptist Comprehensive Cancer Center; Winston Salem, NC, USA
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Ferrari A, Quarello P, Mascarin M, Luigi Banna G, Toss A, Sironi G, Zecca M, Cinieri S, Alessandro Peccatori F. Italian pediatric and adult oncology communities join forces for a national project dedicated to adolescents and young adults with cancer. TUMORI JOURNAL 2021; 108:104-110. [PMID: 34841968 DOI: 10.1177/03008916211058790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescents and young adults with cancer have substantially different clinical and psychological needs compared to those of pediatric patients and of older adult patients. We describe the development of an Italian national project dedicated to adolescents and young adults with cancer.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, University of Torino, Italy
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Giuseppe Luigi Banna
- Interdisciplinary Group for Translational Research and Clinical Trials, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Saverio Cinieri
- Medical Oncology Unit and Breast Unit, Ospedale Perrino ASL Brindisi, Italy
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Hippert F, Desing L, Diez S, Witowski A, Bernbeck B, Abele M, Seitz C, Erdmann F, Brecht I, Schneider DT. Rare Tumors in Children and Adolescents - the STEP Working Group's Evolution to a Prospective Registry. KLINISCHE PADIATRIE 2021; 234:146-153. [PMID: 34798669 DOI: 10.1055/a-1675-3145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Very rare tumors (VRT) in children and adolescents have such a low incidence that until recently, they have not been integrated into the clinical and scientific network of pediatric oncology. Data is very limited and consistent treatment strategies are missing. Thus, VRTs are classic orphan diseases. To counteract this problem, the Arbeitsgemeinschaft für Seltene Tumorerkrankungen in der Pädiatrie (STEP) was founded. Here we report on patient recruitment during the first 10 years. Patients Patients aged up to 18 years and not included in any other clinical trial or GPOH registry were included in this analysis. Methods Data was collected from 2008 to 2018 by means of a standardized form. The recorded diagnoses were descriptively analyzed focusing on histology, localization, and year of report. Results A total of 623 patients with VRTs were registered. During 2008-2014, the annual number of registrations was around 40 and is around 90 since 2015. Most frequent diagnoses included tumors of the skin (n=150), tumors of the gastrointestinal tract (n=102), tumors of the gonads (n=77), the ENT region (n=68), and miscellaneous tumors (n=107). Discussion With the establishment of central structures for clinical consultation and documentation of VRTs, the number of registrations increased. Comprehensively, VRTs are as common as other classic pediatric oncology tumors, but extremely heterogeneous in terms of localization, histology, and prognosis. By a centralized and complete registration and analysis of VRTs, also in collaboration with international partners, it is possible to develop treatment strategies and thus greatly increase treatment quality.
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Affiliation(s)
- Felicitas Hippert
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Lena Desing
- Clinic of Pediatrics, Hospital Weiden, Weiden, Germany
| | - Sonja Diez
- Pediatric Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Andrea Witowski
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Benedikt Bernbeck
- Clinic of Pediatrics, Municipal Hospital Dortmund, Dortmund, Germany
| | - Michael Abele
- Pediatric Hematology/Oncology, University Hospital Tubingen Department of Pediatrics, Tubingen, Germany
| | - Christian Seitz
- Pediatric Hematology/Oncology, University Hospital Tubingen Department of Pediatrics, Tubingen, Germany
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ines Brecht
- Pediatric Hematology/Oncology, University Hospital Tubingen Department of Pediatrics, Tubingen, Germany
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Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group. Cancers (Basel) 2021; 13:cancers13215270. [PMID: 34771435 PMCID: PMC8582416 DOI: 10.3390/cancers13215270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Adolescent and young adult cancer survivors face several significant physical/mental health late effects following cancer treatment. These effects may be minimized through healthcare use tailored to young survivors’ needs. Using a cross-sectional study design, we examined the healthcare use of 93 adolescent/young adult cancer survivors (aged 15–39 years), relative to a comparison group of adolescents and young adults recruited from the local community (n = 183). Our cancer survivor group reported greater use of medical and mental health services, and medications during the past six months relative to the comparison group. Our cancer survivor group also reported less psychological distress, and similar work/study participation relative to the comparison group. Survivors who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater healthcare use. Future research is needed to determine whether the healthcare accessed by adolescent and young adult cancer survivors is appropriate and meets their needs. Abstract Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.
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Adolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview. Cancers (Basel) 2021; 13:cancers13194847. [PMID: 34638332 PMCID: PMC8508173 DOI: 10.3390/cancers13194847] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022] Open
Abstract
Worldwide, more than 1.2 million adolescents and young adults (AYAs; those aged 15-39 years) are diagnosed with cancer each year. Although considerable variability exists according to cancer site and stage of disease, the 5-year relative survival at the time of diagnosis has been estimated at >80% for all AYA patients with cancer combined. Extensive survivorship research in recent decades has focused on patients diagnosed with cancer as children (<15 years) and older adults (>39 years), yet few studies to date have reported outcomes specifically for patients diagnosed as AYAs. With increasing incidence and improving survival for many tumor types, leading to the majority of AYA patients with cancer becoming long-term survivors, there is a critical need for research efforts to inform the survivorship care of this growing population. This article describes the population of AYA cancer survivors according to their epidemiology and late and long-term effects, the challenges and models of AYA survivorship care, as well as future opportunities for research and healthcare.
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50
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Friend BD, Schiller GJ. Beyond steroids: A systematic review and proposed solutions to managing acute graft-versus-host disease in adolescents and young adults. Blood Rev 2021; 52:100886. [PMID: 34509319 DOI: 10.1016/j.blre.2021.100886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
The outcomes of allogeneic hematopoietic cell transplantation (HCT) in adolescents and young adults (AYAs) with hematologic malignancies have been shown to be poorer when compared to results in children, due to a combination of higher relapse rates and greater treatment-related mortality (TRM). Although differences in relapse risk have been studied extensively, toxicity has been examined and reported less often. In this systematic review, we summarize recently published studies that have examined the differences in rates of TRM and acute graft-versus-host disease (GVHD) in AYAs and children with hematologic malignancies, and attempt to explain why these disparities exist and how they impact outcomes. In addition, we present best practices for management of steroid-refractory GVHD that are likely to improve survival in this patient population. Further, we propose the development of personalized, risk-based approaches for the prevention and treatment of GVHD that incorporate novel platforms and interventions. We believe this individualized approach is likely to reduce toxicity and greatly improve outcomes for this vulnerable population.
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Affiliation(s)
- Brian D Friend
- Department of Pediatrics, Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Ave, Suite 1630, Houston, TX 77030, USA.
| | - Gary J Schiller
- Department of Medicine, Division of Hematology-Oncology, University of California Los Angeles, 10833 Le Conte Ave, 42-121 CHS, Los Angeles, CA 90095, USA.
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