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Kleinlugtenbelt LB, Gorter JW, van Dalen EC, Ketelaar M, Tissing WJE. Integrated care networks in multidisciplinary rehabilitation therapy services for childhood oncology close to home: lessons learned from an international environmental scan. Support Care Cancer 2025; 33:406. [PMID: 40266368 PMCID: PMC12018495 DOI: 10.1007/s00520-025-09421-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 03/29/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND Integrated care networks (ICNs) close to home have the potential to improve continuity and quality of care for children with cancer and their families during and after treatment. Our goal is to develop such a network for multidisciplinary rehabilitation therapy services (RTS) in The Netherlands, but we lacked a good understanding of an ICN and the factors to make it successful. PURPOSE The aim of the study was to learn from initiatives in ICN's internationally, how are ICN's developed, how does it promote collaboration and what are facilitators and barriers in its development and use? METHODS We performed an environmental scan. First, we performed a systematic literature search (PubMed) focussing on ICNs for childhood oncology. Secondly, we sent a survey regarding development and use of ICNs to international childhood cancer centers. Participating centers were asked to share information about their initiatives in providing care close to home. Data were summarized descriptively and analyzed using content analysis. RESULTS The literature search did not reveal any relevant publications. The results from the survey, including15 countries, provided valuable insights in the understanding of a good ICN, its facilitators and barriers, and the potential added value of developing ICNs close to home to provide continuity and quality of care. CONCLUSIONS Our study highlights the perceived importance of ICNs for multidisciplinary RTS in pediatric oncology and provides valuable information for the formation of such a network. Information about the needs from the perspectives of children and parents is currently missing and essential to develop successful ICNs.
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Affiliation(s)
| | - J W Gorter
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and de Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - E C van Dalen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and de Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Bellavance C, Lalonde B, Simonyan D, Jabado N, Perreault S, Larouche V. Epidemiology of Pediatric Tumors in Quebec: A 17-Year Report of Cancer in Young People in the Canada Registry. Curr Oncol 2024; 31:2689-2699. [PMID: 38785485 PMCID: PMC11119085 DOI: 10.3390/curroncol31050204] [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: 03/13/2024] [Revised: 04/16/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Cancer is the leading cause of disease-related death among children of more than 1 year of age. However, childhood cancer risk factors and etiology are yet to be fully understood. The goal of this study is to identify geographic variation among children and adolescents diagnosed with pediatric tumors between 2001 and 2018 in the province of Quebec. METHODS We analyzed pediatric patients less than 15 years of age from the Cancer in Young People in Canada (CYP-C) surveillance system who were diagnosed between 2001 and 2018 with cancer in the province of Quebec. The age-standardized age-adjusted incidence rates (AAIR) per 100,000 person years were calculated for all childhood cancers by cancer subgroups, Quebec Health regions, and age groups. RESULTS Overall, 3904 pediatric patients less than 15 years old were diagnosed with cancer in the province of Quebec in 2001-2018. The overall incidence rate (IR) in the province of Quebec was 16.14 (95%CL [15.56-16.73]) per 100,000 person years. For childhood cancers, regions that presented a higher AAIR were Chaudière-Appalaches and Capitale-Nationale with 18.2 and 17.5 per 100,000 person years, respectively. The incidence rates (IRs) in Chaudière-Appalaches (95% CI 1.0439-1.3532) and in Capitale-Nationale (95% CI 1.0124-1.2942) were statistically higher than the incidence in the province of Quebec (p = 0.0090 and p = 0.0310, respectively). When comparing the AAIR of the CNS tumor subgroup in Chaudière-Appalaches and in Capitale-Nationale, with the provincial average, we noticed a statistically higher incidence in Chaudière-Appalaches and a trend for Capitale-Nationale (p < 0.0001 and p = 0.0602, respectively). CONCLUSION There is evidence of spatial clusters in Chaudière-Appalaches and Capitale-Nationale as areas for all childhood cancers. Further studies should be performed to investigate potential risk factors in these regions.
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Affiliation(s)
| | - Benoit Lalonde
- Geography Department, Laval University, Quebec, QC GIV 0B3, Canada
| | - David Simonyan
- Research Center, CHU de Quebec-Université Laval, Quebec, QC G1L 3L5, Canada
| | - Nada Jabado
- Division of Hematology-Oncology, Montreal Children’s Hospital, Department of Pediatrics, McGill University, Montreal, QC H3A 0G4, Canada
| | - Sebastien Perreault
- Division of Pediatric Neurology, Department of Neurosciences, CHU Ste-Justine, Montreal, QC H3T 1C5, Canada
| | - Valérie Larouche
- Department of Pediatric Hemato-Oncology, CHU de Quebec-Université Laval, Centre Mère-Enfant Soleil, Quebec, QC G1V 4G2, Canada
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A Population-Based Analysis of 30-Year Mortality among Five-Year Survivors of Adolescent and Young Adult Cancer: The Roles of Primary Cancer, Subsequent Malignancy, and Other Health Conditions. Cancers (Basel) 2021; 13:cancers13163956. [PMID: 34439115 PMCID: PMC8394271 DOI: 10.3390/cancers13163956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Cancer survivors are at risk for developing serious health problems and dying prematurely. Adolescents and young adults (AYAs, aged 15–39 years at diagnosis) are a unique population challenged with different cancer types and treatment toxicity than other age groups, impaired access to care, financial hardship, and psychosocial distress due to their life stage. Although 85% of AYAs with cancer are alive 5 years after diagnosis, in subsequent years, their survival is consistently lower and declines faster than the general population. However, knowledge regarding why these long-term survivors of AYA cancer die prematurely is incomplete. Therefore, we sought to provide a detailed report of all causes of death in this population, including recurrence of the first cancer, development of a different cancer type, or other health problems. Our results can help inform future research to develop safer cancer treatment and better long-term care that will improve the health and survival of this vulnerable population. Abstract Despite an aggregate 5-year survival of 85%, many adolescents and young adults (AYAs, 15–39 years old) treated for cancer die prematurely decades later. To develop a more complete understanding of this problem, particularly the role of specific subsequent malignant neoplasms (SMNs), we used the SEER-9 registry to analyze causes of death (COD: Primary cancer, SMN, non-malignant conditions) among 162,317 AYAs diagnosed with first cancer between 1975–2012 and surviving 5 or more years. Cumulative mortality, attributable mortality, standardized mortality ratios (SMRs), and adjusted hazard ratios were determined for each cancer site and COD. At 30 years, cumulative mortality due to primary cancer was matched by that due to all other causes (12.8% 95% CI [12.5%, 13.0%] for primary cancer versus 12.8% [12.5%, 13.1%] for all other causes combined) in the combined cohort, and was overtaken by non-malignant conditions in Hodgkin lymphoma, testicular, cervical/uterine, and thyroid cancers. Overall, SMNs accounted for 20% of malignant deaths, the most common being lung/bronchus (25.6%), colorectal/liver/biliary/pancreas (19.1%), and breast (10.2%). For non-malignant conditions, excess risk was noted overall (SMR 1.37, 95% CI [1.34, 1.40]) and for infectious (1.97 [1.85, 2.10]), renal (1.85 [1.60, 2.13]), cardio/cerebrovascular (1.38 [1.33, 1.43]), and suicide (1.15 [1.04, 1.27]). Racial minorities were at significantly higher risk across all COD. Safer therapy, longitudinal monitoring, and primary/secondary preventive strategies are needed to reduce late mortality in this vulnerable population.
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Nowe E, Stöbel-Richter Y, Sender A, Leuteritz K, Friedrich M, Geue K. Cancer-related fatigue in adolescents and young adults: A systematic review of the literature. Crit Rev Oncol Hematol 2017; 118:63-69. [PMID: 28917270 DOI: 10.1016/j.critrevonc.2017.08.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 08/03/2017] [Accepted: 08/18/2017] [Indexed: 11/15/2022] Open
Abstract
Adolescents and young adults with cancer (AYA) represent a specific age cohort dealing with the disease in a stage of life characterized by development, upheavals, and establishment. The aim of this study was to point out the state of research on how AYA are affected by cancer-related fatigue (CRF). RESULTS Twelve articles were included. CRF was found to be higher in AYA than in either of the comparison groups, healthy peers and older cancer patients. Most included studies did not measure CRF with multidimensional, fatigue-specific instruments. CONCLUSION We found a gap in research concerning CRF in AYA. The existing findings suggest that CRF is a significant issue for AYA cancer patients. However, less is known about the prevalence, severity, and impact of CRF in AYA, and their treatment. This should be considered in future research, and risk and prevention factors should be ascertained. Multidimensional and fatigue-specific measuring tools should be used to do this.
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Affiliation(s)
- E Nowe
- Universitätsklinikum Leipzig, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany.
| | - Y Stöbel-Richter
- University of Zittau/Goerlitz, Faculty of Management and Cultural Sciences, P. O. Box 30 06 48, Goerlitz 02811, Germany
| | - A Sender
- Universitätsklinikum Leipzig, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - K Leuteritz
- Universitätsklinikum Leipzig, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - M Friedrich
- Universitätsklinikum Leipzig, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - K Geue
- Universitätsklinikum Leipzig, Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
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Le A, Mitchell HR, Zheng DJ, Rotatori J, Fahey JT, Ness KK, Kadan-Lottick NS. A home-based physical activity intervention using activity trackers in survivors of childhood cancer: A pilot study. Pediatr Blood Cancer 2017; 64:387-394. [PMID: 27615711 DOI: 10.1002/pbc.26235] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/29/2016] [Accepted: 08/02/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over 70% of childhood cancer survivors develop late complications from therapy, many of which can be mitigated by physical activity. Survivors engage in exercise at similar or lower rates than their sedentary healthy peers. We piloted a novel home-based exercise intervention with a motivational activity tracker. We evaluated (i) feasibility, (ii) impact on activity levels and physical fitness, and (iii) barriers, preferences, and beliefs regarding physical activity. METHODS Childhood cancer survivors currently 15 years or older and not meeting the Centers for Disease Control and Prevention physical activity guidelines were enrolled and instructed to wear the Fitbit One, a 4.8 cm × 1.8 cm motivational activity tracker, daily for 6 months. Baseline and follow-up evaluations included self-report surveys, an Actigraph accelerometer for 7 days, and a VO2 maximum test by cardiac stress test. RESULTS Nineteen participants were enrolled (13.4% participation rate) with a mean age of 24.3 ± 5.8 years (range 15-35). Four participants withdrew with a 79% retention rate. Participants wore the Fitbit an average of 19.0 ± 4.7 days per month during months 1-3 and 15.0 ± 7.9 days per month during months 4-6. Total weekly moderate to vigorous physical activity increased from 265.6 ± 117.0 to 301.4 ± 135.4 min and VO2 maximum increased from 25.7 ± 7.7 to 27.2 ± 7.4 ml/kg/min. These changes were not statistically significant (P = 0.47 and 0.30, respectively). Survey responses indicated no change in barriers, preferences, and beliefs regarding physical activity. CONCLUSIONS This pilot study of a motivational activity tracker demonstrated feasibility as measured by participant retention, receptivity, and belief of utility. Future studies with a large sample size are needed to demonstrate the efficacy and sustainability of this intervention.
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Affiliation(s)
- Alyssa Le
- Department of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Hannah-Rose Mitchell
- Department of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Daniel J Zheng
- Department of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Jaime Rotatori
- Department of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut
| | - John T Fahey
- Department of Pediatric Cardiology, Yale School of Medicine, New Haven, Connecticut
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nina S Kadan-Lottick
- Department of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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Samuelson C, O'Toole L, Boland E, Greenfield D, Ezaydi Y, Ahmedzai SH, Snowden JA. High prevalence of cardiovascular and respiratory abnormalities in advanced, intensively treated (transplanted) myeloma: The case for 'late effects' screening and preventive strategies. ACTA ACUST UNITED AC 2016; 21:272-9. [PMID: 27077780 PMCID: PMC4950454 DOI: 10.1080/10245332.2015.1122258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Modern management of myeloma has significantly improved survival, with increasing numbers of patients living beyond a decade. However, little is known about the long-term cardiovascular and respiratory status of intensively treated and multiply relapsed survivors. Methods: We performed detailed cardiovascular and respiratory evaluations in patients with intensively treated, advanced but stable myeloma. All patients had received at least two lines of treatment, including at least one haematopoietic stem cell transplantation procedure, but had stable, controlled disease and were off active treatment at the time of evaluation. Results: Thirty-two patients with a median duration of 6 years (range 2–12) from original diagnosis of myeloma and three lines (range 2–6) of treatment were evaluated. Despite normal physical examination in the majority, there was a high prevalence of sub-clinical cardiac and respiratory dysfunction, reflected by abnormalities of electrocardiography (45%), echocardiography (50%), serum N-terminal pro-B-type natriuretic peptide level (NT-pro-BNP, 50%), and pulmonary function testing (45%). NT-pro-BNP level correlated negatively with quality of life (P = 0.012) and positively with serum ferritin (P = 0.027). Dyspnoea score correlated with BMI (P = 0.001). Risk factors for cardiovascular disease (obesity, hypertension, hyperlipidaemia, and hyperinsulinaemia) were common. Discussion: Even in the absence of overt clinical features, the majority of intensively treated long-term survivors of myeloma have established cardiovascular and/or respiratory dysfunction, above levels expected in the general population of a similar age. Conclusion: This study supports routine screening and lifestyle modification combined with primary and secondary preventive strategies to reduce cardiovascular and respiratory disease and to preserve quality of life in transplanted myeloma patients.
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Affiliation(s)
- Clare Samuelson
- a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Laurence O'Toole
- b Department of Cardiology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Elaine Boland
- c Academic Unit of Supportive Care , University of Sheffield , UK
| | - Diana Greenfield
- d Department of Oncology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Yousef Ezaydi
- a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
| | - Sam H Ahmedzai
- c Academic Unit of Supportive Care , University of Sheffield , UK
| | - John A Snowden
- a Department of Haematology , Sheffield Teaching Hospitals NHS Foundation Trust , UK
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Preferences for the organization of long-term follow-up in adolescent and young adult cancer survivors. Support Care Cancer 2016; 24:3425-36. [PMID: 26988228 DOI: 10.1007/s00520-016-3157-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE As survival rates of adolescent and young adult (AYA) cancer patients increase, a growing number of AYA cancer survivors need follow-up care. However, there is little research on their preferences for follow-up care. We aimed to (1) describe AYA cancer survivors' preferences for the organization and content of follow-up care, (2) describe their preferences for different models of follow-up, and (3) investigate clinical and sociodemographic characteristics associated with preferences for the different models. METHODS AYA cancer survivors (diagnosed with cancer at age 16-25 years; ≥5 years after diagnosis) were identified through the Cancer Registry Zurich and Zug. Survivors completed a questionnaire on follow-up attendance, preferences for organizational aspects of follow-up care (what is important during follow-up, what should be included during appointments, what specialists should be involved, location), models of follow-up (telephone/questionnaire, general practitioner (GP), pediatric oncologist, medical oncologist, multidisciplinary team), and sociodemographic characteristics. Information on tumor and treatment was available through the Cancer Registry Zurich and Zug. RESULTS Of 389 contacted survivors, 160 (41.1 %) participated and 92 (57.5 %) reported still attending follow-up. Medical aspects of follow-up care were more important than general aspects (p < 0.001). Among different organizational models, follow-up by a medical oncologist was rated higher than all other models (p = 0.002). Non-attenders of follow-up rated GP-led follow-up significantly higher than attenders (p = 0.001). CONCLUSION Swiss AYA cancer survivors valued medical content of follow-up and showed a preference for medical oncologist-led follow-up. Implementation of different models of follow-up care might improve accessibility and attendance among AYA cancer survivors.
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Mitra D, Hutchings K, Shaw A, Barber R, Sung L, Bernstein M, Carret AS, Barbaros V, McBride M, Parker L, Stewart M, Strahlendorf C. Status Report – The Cancer in Young People in Canada surveillance system. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2015; 35:73-6. [PMID: 26083522 DOI: 10.24095/hpcdp.35.4.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Mitra
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - K Hutchings
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - A Shaw
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - R Barber
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - L Sung
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - M Bernstein
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - A S Carret
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - V Barbaros
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - M McBride
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - L Parker
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - M Stewart
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Nikfarid L, Rassouli M, Borimnejad L, Alavimajd H. Chronic Sorrow in Mothers of Children With Cancer. J Pediatr Oncol Nurs 2015; 32:314-9. [DOI: 10.1177/1043454214563407] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic sorrow, a progressive, persistent, and endless feeling of grief, is seen in parents of children with chronic diseases. This study aimed to investigate chronic sorrow in mothers of children with cancer in selected hospitals in Tehran, Iran. It also sought to clarify the relationships between chronic sorrow and some demographic characteristics. In this descriptive, cross-sectional study, 264 mothers attending 3 pediatric teaching hospitals in Tehran were selected using convenience sampling. The subjects completed a demographic questionnaire and Kendall Chronic Sorrow Questionnaire (Persian version). Data were analyzed with descriptive and inferential (Mann-Whitney and Kruskal-Wallis tests) statistics in SPSS 16.0. The mean score on the Kendall Chronic Sorrow Questionnaire was 76.39 ± 15.81. Chronic sorrow was likely present or present in 97.7% of the mothers (n = 252). The mean scores on the Disparity, Sadness, and Getting Along subscales were 30.26 ± 104.209, and 33.38 ± 42.777, respectively, and the mean score for coping was 12.75 ± 11.922. The relationships between most demographic characteristics and scores on the Kendall Chronic Sorrow Questionnaire were not significant. Chronic sorrow is a concept experienced by families of children with cancer. The health care provider’s knowledge about this concept and its components can facilitate the development of better support and treatment programs and lead to improved quality of life for children and their families.
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Affiliation(s)
- Lida Nikfarid
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leili Borimnejad
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences and Health Services, Tehran, Iran
| | - Hamid Alavimajd
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dreyer J, Schwartz-Attias I. Nursing care for adolescents and young adults with cancer: literature review. Acta Haematol 2014; 132:363-74. [PMID: 25228562 DOI: 10.1159/000360213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cancer patients belonging to the adolescent and young adult (AYA) age group have unique and very specific needs, which require special attention from the caring staff. The difficulty in maintaining the personal and professional development at this age is both natural and normal. Adding to this, coping with a life-threatening disease turns this stage in life into a period with many dilemmas and challenges of quite a complex nature. AYA patients have to deal with issues above and beyond the disease itself, which create a very complex coping picture. On top of that, prognosis for this age group has not improved in recent years, unlike the situation in other age groups like children and adults. The literature on this subject is extensive and comprehensive. However, most of the papers on this subject are very specific and narrow in their approach, each dealing with a specific topic. In this article, we bring together many different papers which make a wide and comprehensive picture of the subject of AYAs coping with cancer, coupled with recommendations for the caring staff. In this review we focus on the various aspects of the disease and treatments in AYAs, based on the conceptual model of quality of life proposed by Ferrell and colleagues [Cancer Nurs 1992;15:153-160; Cancer Nurs 1992;15:247-253], including physical, social, emotional and spiritual aspects. From the psychological standpoint, most of the papers discuss the negative aspects; however, in this article we try to include some articles from the positive psychology school of thought. From our findings it is apparent that there is an opportunity and need to further explore research in this regard. It is apparent that taking a unique approach to AYA cancer patients is needed in order to deal with the unique needs of this age group. This article aims at putting a framework around this issue, with actionable recommendations for the caring staff.
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Affiliation(s)
- Juliet Dreyer
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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Greenfield DM, Boland E, Ezaydi Y, Ross RJM, Ahmedzai SH, Snowden JA. Endocrine, metabolic, nutritional and body composition abnormalities are common in advanced intensively-treated (transplanted) multiple myeloma. Bone Marrow Transplant 2014; 49:907-12. [DOI: 10.1038/bmt.2014.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/30/2014] [Accepted: 02/02/2014] [Indexed: 11/09/2022]
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Casagranda L, Trombert-Paviot B, Faure-Conter C, Bertrand Y, Plantaz D, Berger C. Self-reported and record-collected late effects in long-term survivors of childhood cancer: a population-based cohort study of the childhood cancer registry of the Rhône-Alpes region (ARCERRA). Pediatr Hematol Oncol 2013; 30:195-207. [PMID: 23484904 DOI: 10.3109/08880018.2013.772682] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We compared long-term health effects induced by childhood cancer or its treatments as reported by young adult survivors and as noted in their medical records. PATIENTS AND METHODS We analyzed and compared health problems reported by 192 young adults treated for childhood cancer between 1987 and 1992 who were included in the population-based childhood cancer registry of the Rhône-Alpes region and those effects inventoried by their healthcare providers in medical records. RESULTS Of 14 types of late effects studied, each patient reported experience of 0 to 11 (average 2.8 ± 2.1), and their medical records indicated 0 to 8 (average 1.8 ± 1.7) (P < .001). No late effect was reported by 10.4% of the 192 patients and/or noted in the medical records of 21.9% (P = .048). Only eight patients reported and were observed to experience none of the 14. Nine of the 14 were reported significantly more frequently by survivors than their medical records. Only one of eight survivors with cardiomyopathy reported its presence (P = .008), whereas alopecia was reported 13 times by survivors, once by medical records, and three times by both (P = .001). CONCLUSION The disparity between reports of late effects by survivors and medical records underscores the need for better communication between survivors and their health care providers. It is important to recognize the potential for bias from both under- and over-reporting in studies based only on survivor self-report. More thorough observation of late effects among survivors of childhood cancer might result from the implementation of a late-effects clinic.
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Affiliation(s)
- Léonie Casagranda
- Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, Saint-Etienne, Cedex, France.
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Berg C, Hayashi RJ. Participation and Self-Management Strategies of Young Adult Childhood Cancer Survivors. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2012. [DOI: 10.3928/15394492-20120607-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study describes a connection between late effects, engagement in major life activities, and self-management strategies in young adult childhood cancer survivors. A mailed survey focused on late effects of pain, fatigue, depression, cognition, memory, and body image distortion and their impact on work, education, independent living, and community and social engagement. Additionally, survivors identified self-management strategies that minimize their late effects. Eighty-eight percent of the 42 responders struggled with at least one of the six late effects. Work and educational pursuits were affected, with memory and fatigue the most intrusive to daily activities. Self-management strategies of sleep/rest, fitness, quiet leisure, and support of family/friends were the most common. Reaching out to long-term follow-up cancer clinics, health professionals, survivors, or community resources were the least employed management strategies. Occupational therapists can look to community models for educating survivors about self-management, and take this opportunity to define new collaborative partnerships with long-term follow-up cancer clinics and community agencies to assist young adult survivors transitioning to adult roles.
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Snowden JA, Saccardi R, Allez M, Ardizzone S, Arnold R, Cervera R, Denton C, Hawkey C, Labopin M, Mancardi G, Martin R, Moore JJ, Passweg J, Peters C, Rabusin M, Rovira M, van Laar JM, Farge D. Haematopoietic SCT in severe autoimmune diseases: updated guidelines of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2012; 47:770-90. [PMID: 22002489 PMCID: PMC3371413 DOI: 10.1038/bmt.2011.185] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/04/2011] [Accepted: 07/04/2011] [Indexed: 12/13/2022]
Abstract
In 1997, the first consensus guidelines for haematopoietic SCT (HSCT) in autoimmune diseases (ADs) were published, while an international coordinated clinical programme was launched. These guidelines provided broad principles for the field over the following decade and were accompanied by comprehensive data collection in the European Group for Blood and Marrow Transplantation (EBMT) AD Registry. Subsequently, retrospective analyses and prospective phase I/II studies generated evidence to support the feasibility, safety and efficacy of HSCT in several types of severe, treatment-resistant ADs, which became the basis for larger-scale phase II and III studies. In parallel, there has also been an era of immense progress in biological therapy in ADs. The aim of this document is to provide revised and updated guidelines for both the current application and future development of HSCT in ADs in relation to the benefits, risks and health economic considerations of other modern treatments. Patient safety considerations are central to guidance on patient selection and HSCT procedural aspects within appropriately experienced and Joint Accreditation Committee of International Society for Cellular Therapy and EBMT accredited centres. A need for prospective interventional and non-interventional studies, where feasible, along with systematic data reporting, in accordance with EBMT policies and procedures, is emphasized.
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Affiliation(s)
- J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - R Saccardi
- Department of Haematology, Careggi University Hospital, Firenze, Italy
| | - M Allez
- Service de Gastroentérologie, INSERM U 662, Hôpital St Louis, Paris, France
| | - S Ardizzone
- Department of Gastroenterology, Sacco University Hospital, Milan, Italy
| | - R Arnold
- Charite Hospital Berlin, Berlin, Germany
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - C Denton
- Centre for Rheumatology, Royal Free and University College Medical School, Hampstead, London, UK
| | - C Hawkey
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - M Labopin
- Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Univ Paris 06, Paris, France
| | - G Mancardi
- Department of Neuroscience, Ophthalmology and Genetics, University of Genova, Genova, Italy
| | - R Martin
- Institute for Neuroimmunology and Clinical MS Research, Hamburg, Germany
| | - J J Moore
- St Vincent's Hospital, Sydney, NSW, Australia
| | - J Passweg
- Universitaetsspital Basel, Basel, Switzerland
| | - C Peters
- BMT Unit, St Anna Children's Hospital, Vienna, Austria
| | - M Rabusin
- BMT Unit, Department of Pediatrics, Institute of Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - M Rovira
- SCT Unit, Hematology Department, Hospital Clinic, Barcelona, Spain
| | | | - D Farge
- Department of Internal Medicine, INSERM U 796, Hôpital St Louis, Paris, France
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Bradley Eilertsen ME, Jozefiak T, Rannestad T, Indredavik MS, Vik T. Quality of life in children and adolescents surviving cancer. Eur J Oncol Nurs 2012; 16:185-93. [DOI: 10.1016/j.ejon.2011.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 08/15/2011] [Accepted: 08/18/2011] [Indexed: 01/15/2023]
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Lewis FM, Su IF, Murdoch BE. Indices of language outcome 11 years after intrathecal chemotherapy for acute lymphoblastic leukemia: a sibling case-control study. Pediatr Hematol Oncol 2012; 29:176-90. [PMID: 22303906 DOI: 10.3109/08880018.2011.627417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Studies are emerging that suggest that major language indices do not differentiate children treated for acute lymphoblastic leukemia (ALL) with risk-adapted intrathecal chemotherapy (ITC) from control children matched on age, gender, and educational level. No study to date has controlled for cognitive environment, an important variable influencing language achievement and outcome. This case-control study applies the deconfounding principle by using a sibling as a control to investigate language outcomes in a male child 11 years after administration of ITC for ALL at the age of 2 years 3 months. A comprehensive behavioral language test battery failed to differentiate the siblings on current language performance when descriptively compared, but neurophysiological assessment revealed that the ITC-treated child required more time and elicited a smaller N400 component compared to his sibling during picture-word matching. The findings suggest that in the absence of pretreatment performance indices, comparison with sibling achievement may supplement what is known on posttreatment language skill development drawn from comparative studies using children matched on age, sex, and educational level drawn from the community. The study's findings offer pilot data of language outcomes following ITC beyond the early stage of survivorship. The benefits and limitations of using siblings in research where the cognitive environment is known to make an important contribution to skill development are discussed.
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Affiliation(s)
- Fiona M Lewis
- Centre for Neurogenic Communication Disorders Research, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Snowden JA, Ahmedzai SH, Ashcroft J, D’Sa S, Littlewood T, Low E, Lucraft H, Maclean R, Feyler S, Pratt G, Bird JM. Guidelines for supportive care in multiple myeloma 2011. Br J Haematol 2011; 154:76-103. [DOI: 10.1111/j.1365-2141.2011.08574.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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