How confident are young adult cancer survivors in managing their survivorship care? A report from the LIVESTRONG™ Survivorship Center of Excellence Network

Health Knowledge in Adolescent Childhood Cancer Survivors at High Risk for Therapy-Related Cardiotoxicity

Childhood cancer survivors' (CCS) knowledge about late effects can promote positive health behaviors and autonomy. Cardiotoxicity is a major source of morbidity, which can be mitigated through exercise. Descriptive and Fisher's exact statistics were used to characterize health knowledge and physical activity in CCS ≥13 years at high risk for cardiotoxicity. Of 16 CCS (mean age 17.0 ± 2.1 years), 3 (18.8%) identified previous anthracycline exposure, and 5 (31.2%) had adequate physical activity. Of survivors <18 years, 82% had poor late effects knowledge (p = 0.005). Knowledge was not associated with physical activity (p = 0.60). Interventions are needed to improve late effects knowledge in adolescent CCS.

Design and methods of a multi-level intervention to improve adherence to childhood cancer survivorship care by partnering with primary care providers: The BRIDGES randomized controlled trial

BACKGROUND

Despite heightened risk of chronic health conditions, <20 % of childhood cancer survivors (CCS) receive guideline-recommended surveillance for late effects. Barriers include avoidance of reminders, lack of knowledge, and costs. The goal of the BRIDGES Study is to evaluate the effects of a multi-level, remote intervention on adherence to guideline-recommended surveillance among CCS by partnering with primary care providers (PCPs).

METHODS

This ongoing study is a multi-site, two-arm, prospective, parallel design, 1:1 randomized controlled non-inferiority trial (N = 240; n = 120/group). Eligibility criteria are: cancer diagnosis at age < 21 years, 2.0-4.0 years post-cancer therapy, and no previous specialty survivorship clinic care. The intervention includes: 1) patient survivorship education via telehealth with a cancer center nurse, including discussion of patient's individualized survivorship care plan (SCP), 2) ongoing patient-tailored health education within the electronic health record's patient portal, 3) a structured interactive phone call between the cancer center nurse and PCP, including discussion of patient's SCP, and 4) an in-person PCP visit for survivorship care. Patients randomized to the comparison group are contacted to schedule an in-person visit at their cancer center-based survivorship clinic. Adherence to guideline-recommended surveillance tests (primary outcome) is assessed at 1-year post-randomization (primary follow-up time point) and 2-years post-randomization (for durability). Patient knowledge, self-efficacy, and activation; PCP knowledge and self-efficacy; and process outcomes are also assessed.

CONCLUSION

Models of survivorship care that overcome existing barriers are needed. If efficacious, this scalable, remote intervention would be a valuable strategy to address barriers and bridge gaps in care to reach more CCS.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05448560.

Understanding post-treatment self-management learning needs of young adults diagnosed with hematological cancer: a qualitative study

PURPOSE

To better support and promote an active role in survivorship, the purpose of this study was to identify and understand the perspective of young adults diagnosed with a hematological cancer in regard to their post-treatment self-management learning needs.

METHOD

An interpretative-descriptive study was conducted. Semi-structured individual interviews were carried out with eight young adults (ages 18 to 29 at the end of active treatment), diagnosed with a leukemia or lymphoma, who have not received active treatment for at least one year. Iterative content analysis of interview data was performed.

RESULTS

According to participants, it is when young adults experience transitions or feel alone in dealing with post-treatment challenges that they can identify a learning need. Protective factors and precipitating factors related to young adults, their entourage and their care providers (e.g., young adult characteristics, level of support, quality of patient education) can contribute to shape their view of self-management learning needs. For young adults, an underlying motivation guides the identification of attitudes (autonomy, responsibility, acceptance), knowledge (physical and psychosocial challenges, rights to accommodation for disability) or skills (self-assessment, action-planning, self-advocacy) to be gained.

CONCLUSIONS

This study supports that young adults need more than information to feel confident in their ability to self-manage post-treatment challenges. Learning to self-manage is therefore a process of personal transformation, fueled by internal motivation, that also benefits from external support through collaboration between young adults, their entourage, and their care providers including oncology nurses.

Addressing Akrasia in Childhood, Adolescent and Young Adult Cancer Survivors: Implications for Long-Term Follow-Up and Preventive Health Interventions

BACKGROUND

Childhood, adolescent, and young adult cancer survivors (CAYACS) face significant long-term health risks, yet adherence to long-term follow-up (LTFU) care remains inconsistent. This study explores the concept of akrasia (i.e., acting against one's better judgment by engaging in behaviors known to be harmful or counterproductive) to understand the psychological, cognitive, and systemic barriers influencing survivor engagement in LTFU.

METHOD

Using an ethical reflection approach based on a literature review, we discussed survivor experiences, behavioral science insights, and ethical principles to identify solutions that balance patient autonomy with supportive interventions. A narrative approach was used to summarize the key points discussed during the ethics reflection group meetings.

RESULTS

Our findings highlight key barriers such as trauma, avoidance behaviors, and cognitive constraints that contribute to non-adherence. Strategies such as shared decision-making, digital health tools, and nudge-based interventions are proposed to enhance survivor engagement. Ethical considerations emphasize the need for personalized and flexible care approaches that respect survivor agency while mitigating obstacles to adherence.

CONCLUSIONS

Addressing akrasia through ethical and behavioral frameworks could improve LTFU adherence, ultimately enhancing survivorship care and long-term health outcomes.

Development of a rehabilitation programme for young adult cancer survivors using co-production

BACKGROUND

Young adult cancer survivors, defined as individuals aged 18-39 who have completed primary curative treatment, face numerous age-specific biopsychosocial late effects that impact health-related quality of life negatively. Rehabilitation can enhance participation in life roles, work, leisure activities and health-related quality of life. However, there is a lack of age-specific cancer rehabilitation for this population, leaving many young adults with diminished self-efficacy in managing their challenges, resulting in unmet needs. This study aimed to co-produce and develop an age-specific, municipality-based cancer rehabilitation intervention programme to improve young adults' self-efficacy and health-related quality of life.

METHODS

The development process was completed between September 2019 and June 2023 and followed Hawkins et al.'s three-staged framework for co-production: (1) A literature review and stakeholder consultations; (2) four workshops with 2-6 young adult cancer survivors, 3-4 professionals, and two researchers and one workshop with 20 young adult cancer survivors and two researchers to co-produce the name, component content, delivery methods and potential outcomes; and (3) Refinement of the programme and its programme theory. Key findings from each stage informed the subsequent stages.

RESULTS

The Young Adults Taking ACtion programme was developed. It applies a person-centred approach and is grounded in social cognitive theory and experiential learning theory. It comprises one mandatory component, a needs assessment and goal setting that tailor which of the following seven components the young adults will receive: (1) everyday life, (2) physical activity, (3) psychological issues, (4) education and work, (5) sexuality and relationships, (6) funds and grants, and (7) family and friends. The programme is primarily group-based and will be delivered by an interdisciplinary team over 16 weeks.

CONCLUSIONS

We co-produced a comprehensive, goal-oriented, and peer-based rehabilitation programme for young adult cancer survivors. The engagement of young adults and professionals ensured that the programme aligned with the population's needs and preferences and was context specific. Thus, it is likely that the programme will be more realistic and feasible to implement in clinical practice.

A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations

PURPOSE

Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes.

METHODS

Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria.

RESULTS

Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs.

CONCLUSIONS

Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups.

IMPLICATIONS FOR CANCER SURVIVORS

SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.

History and current status of the survivorship care program at the University of California, Los Angeles Jonsson Comprehensive Cancer Center (UCLA JCCC)

As one of the first comprehensive cancer centers to receive a designation from the National Cancer Institute, the Jonsson Comprehensive Cancer Center at UCLA Health has served as a leader in survivorship research for three decades. A clinical survivorship program for childhood cancer survivors was established in the early 2000s as this became a standard of care in pediatric oncology. However, it was not until receipt of external funding and the establishment of a Survivorship Center of Excellence in 2006 that clinical services were expanded to include adult cancer survivors, as well as survivorship care delivery research in the community and at affiliated clinical sites. When this funding ended, there was limited institutional support for expansion of the program, and so the clinical programs did not develop further. Recently, there has been renewed interest in obtaining Commission on Cancer accreditation, and this has prompted an institutional assessment of survivorship care to inform future activities for system-wide program development. As oncology care expands throughout a large regional health system network, the future survivorship program will need to serve as a common resource for the entire health system by providing a repository of specialized services and resources as well as standard processes and pathways for a cohesive approach to care. IMPLICATIONS FOR CANCER SURVIVORS: There are many challenges to development and sustainment of cancer survivorship programs, even in NCI-designated comprehensive cancers. As the delivery of cancer care services expands and becomes more integrated in large health care systems, innovative strategies are needed to ensure delivery of tailored care to cancer survivors through acute treatment and beyond.

Disparities in care and outcomes for adolescent and young adult lymphoma patients

Though survival outcomes among adolescents and young adults (AYAs) with lymphoma have improved over the last three decades, socially vulnerable populations including non-White, low-income, and publicly insured groups continue to trail behind on survival curves. These disparities, while likely the result of both biological and non-biological factors, can be largely attributed to inequities in care over the full cancer continuum. Nationally representative studies have demonstrated that from diagnosis through therapy and into long-term survivorship, socially vulnerable AYAs with lymphoma face barriers to care that impact their short and long-term survival. Thus, improving outcomes for all AYAs with lymphoma requires dedicated study to understand, and then address the unique challenges faced by non-White and low-income lymphoma populations within this age group.

Lived Experiences of Young Adults With Lymphoma During Acute Survivorship

BACKGROUND

Hodgkin lymphoma and non-Hodgkin lymphoma are hematologic malignancies of the lymphatic system with increased prevalence in young adults. Numerous studies have examined the health-related quality of life dimensions in young adults with lymphoma; yet, limited research has investigated the experiences of this population.

OBJECTIVE

This study aimed to explore the lived experiences of young adults with Hodgkin lymphoma and non-Hodgkin lymphoma ( n = 8) receiving acute treatment from one National Cancer Institute-Designated Cancer Center in the Northeastern United States.

METHODS

A qualitative interpretive phenomenological study design and method was applied to explore the lived experiences of young adults with lymphoma during acute survivorship.

RESULTS

The participants lived experiences were shaped by the diagnostic challenges and impediments of cancer and lymphoma in young adults. Through postdiagnosis, they were determined to safeguard parents and close family members from the burden of cancer. The bonds between medical oncologists and nurses offered the participants a dynamic structure to endure acute survivorship.

CONCLUSION

Cancer was challenging to diagnose in this sample of young adults with lymphoma. The presence of nurses was shown to be deeply impactful for young adults with lymphoma. More research is necessary to understand the experiences of young adults with lymphoma through extended or long-term survivorship.

IMPLICATIONS FOR PRACTICE

Healthcare providers require additional education regarding the diagnostic guidelines in young adult patients with lymphoma. This study underscores the importance of well-defined and structured postdiagnosis survivorship care in young adults with lymphoma.

Improving Cancer Survivorship Care for Latino Adolescent, Young Adult Survivors through Community-Partnered Participatory Research

Background

Minority adolescent and young adult (AYA) cancer survivors experience disparities in receipt of survivorship care.

Objective

This study describes the infrastructure of a community-partnered participatory research (CPPR) project between a community-based organization and a National Cancer Institute (NCI)-designated cancer center to develop culturally-tailored interventions to improve Latino AYA cancer survivor knowledge regarding their need for survivorship care.

Methods

Research team participants included the community organization and NCI cancer center directors, a research coordinator, a community liaison, and cross-training program interns. Through use of Jones's theoretical framework, additional stakeholders from academic and community settings were identified and invited to participate in the research team. A process evaluation and qualitative interviews were conducted to assess equal partnership between community and academic stakeholders and determine if the infrastructure followed the five core principles of CPPR. A grounded theory approach was used to analyze qualitative data.

Conclusions

CPPR between an NCI-designated cancer center and a community-based organization is a new research model for conducting minority AYA cancer survivor outreach. Open communication was critical in engaging the Latino community to discuss their survivorship needs. Community stakeholders were key to infrastructure success through fostering a cohesive partnership with and acting as the voice of the Latino community. Implementing a cross-training program promoted continued engagement of community members with academic partners. Proper infrastructure development is critical to building successful research partnerships in order to develop culturally-tailored interventions to improve survivorship care knowledge.

Engaging Latino Adolescent and Young Adult (AYA) Cancer Survivors in Their Care: Piloting a Photonovela Intervention

Latino adolescent and young adult (AYA) cancer survivors represent a growing population given the changing demographics in the USA. They experience significant healthcare disparities and barriers that warrant age-specific and culturally appropriate interventions to improve their clinical and psychosocial outcomes. This single-arm pilot study evaluated a novel intervention - a photonovela - on its ability to educate Latino AYA survivors and their family members and engage them in survivorship care. Ninety-seven participants (Latino AYA survivors and their family members) were recruited for this study. Three surveys assessing survivorship care confidence, cancer stigma, and survivorship care knowledge were administered to families before they received the photonovela, after the intervention, and at a booster phone call session. Mixed effects models were used to evaluate differences in scores at the three time points while accounting for repeated measures and family clustering. Results show that the photonovela was effective in improving survivorship care confidence and knowledge of Latino AYA survivors and their families. This pilot study indicates that the photonovela has potential to be a useful intervention for improving confidence and knowledge regarding the need to seek survivorship care for Latino AYA cancer survivors.

Cancer survivorship care for young adults: a risk-stratified, multicenter randomized controlled trial to improve symptoms

PURPOSE

Young adult (YA) cancer survivors have high rates of adverse health and psychosocial outcomes. This risk-stratified, multicenter, randomized controlled trial (RCT) compared a self-management survivorship intervention to usual care in YA survivors with symptoms of cancer-related distress, insomnia, fatigue, pain, and/or depression.

METHODS

Eligibility included age 18-39 at diagnosis with an invasive malignancy in the previous 1-5 years. Baseline assessment determined "high need" participants, with 2-5 elevated targeted symptoms. We randomized high need participants to intervention or usual care and offered intervention participants a survivorship clinic visit, which included mutually decided action plans for symptoms. Follow-up calls at 1 and 3 months after the clinic visit reviewed action plan progress. Outcomes compared rates of improved symptoms for intervention vs usual care at 6 months and 12 months.

RESULTS

N = 344 completed baseline assessment, with n = 147 (43%) categorized as high need and randomized. Of n = 73 randomized to the intervention, n = 42 (58%) did not attend their survivorship clinic visit. In intent-to-treat analyses, aggregate symptom scores did not differ between arms, though distress improved for 46% in the intervention arm at 6 months compared to 18% in usual care (p = 0.03) among those with elevated distress at baseline.

CONCLUSIONS

Distress improved for YAs who received self-management survivorship care. However, the study demonstrates a need for alternative strategies for providing YA survivorship care.

TRIAL REGISTRATION

NCT02192333 IMPLICATIONS FOR CANCER SURVIVORS: While YA survivors demonstrate some improved distress when provided survivorship care, to make care accessible and effective, they require options such as remote delivery of care.

Acceptability and feasibility of survivorship care plans and an accompanying mobile health intervention for adolescent and young adult survivors of childhood cancer

BACKGROUND

Self-management interventions for adolescent and young adult (AYA) survivors of childhood cancer are needed. The present study reports on the acceptability and feasibility of delivering survivorship care plans (SCPs) and an accompanying app to AYA.

PROCEDURE

AYA (n = 224) ages 15-29 who completed treatment for cancer were randomized and received a digital SCP only or an SCP plus a mobile app intended to enhance self-management. For 16 weeks, the app delivered one to two daily messages complementing information in their SCP and tailored based on age, treatment, and health goal. Data are presented on feasibility, self-reported acceptability (including satisfaction and perceived benefits) and its relationship to app engagement (for those in app group), and feedback from qualitative interviews conducted with 10 AYA.

RESULTS

The SCP and app proved feasible as evidenced by high recruitment and retention, access to technology, time analysis, moderate app engagement, and minimal technical issues. However, 12% reported never reading the SCP and 8% never used the app. The app and SCP were acceptable to AYA, and SCP acceptability ratings did not differ between groups. For those with the app, acceptability was positively related to message engagement. AYA recommended enhanced individualization and design features of the SCP and app.

CONCLUSIONS

Results support the use of tailored SCPs and mobile health interventions for most AYA, as well as the need for further refinement and research. Delivery of SCPs and digital interventions are acceptable and feasible to AYA survivors, and may help promote health-related knowledge and survivorship self-management.

The use of survivorship care plans by female racial and ethnic minority breast cancer survivors: a systematic review

PURPOSE

Racial/ethnic breast cancer survivorship disparities persist as minority breast cancer survivors (MBCSs) report fragmentation in survivorship care, namely in the access and delivery of survivorship care plans (SCPs). To better understand care coordination of MCBS, this review elucidated concerns of female MBCS about their preparation for post-treatment survivorship care, the preferred practices for the delivery of a SCP, and the associated content to improve post-treatment survivorship care understanding.

METHODS

A systematic search of articles from PubMed, Ovid-Medline, CINAHL databases, and bibliographic reviews included manuscripts using keywords for racial/ethnic minority groups and breast cancer survivorship care coordination terms. Salient themes and article quality were analyzed from the extracted data.

RESULTS

Fourteen included studies represented 5,854 participants and over 12 racial/ethnic groups. The following themes of post-treatment MBCS were identified from the review: (1) uncertainty about post-treatment survivorship care management is a consequence of sub-optimal patient-provider communication; (2) access to SCPs and related materials are desired, but sporadic; and (3) advancements to the delivery and presentation of SCPs and related materials are desired.

CONCLUSIONS

Representation of only 14 studies indicates that the MBCSs' perspective post-treatment survivorship care is underrepresented in the literature. Themes from this review support access to, and implementation of, culturally tailored SCP for MBCS. There was multi-ethnic acceptance of SCPs as a tool to help improve care coordination.

IMPLICATIONS FOR CANCER SURVIVORS

These findings highlight the importance of general education about post-treatment survivorship, post-treatment survivorship needs identification, and the elucidation of gaps in effective SCP delivery among MBCS.

A structural equation modeling approach to understanding pathways linking survivorship care plans to survivor-level outcomes

PURPOSE

Several high-profile organizations have mandated the delivery of survivorship care plans (SCPs) despite mixed evidence regarding the effectiveness of SCPs on key survivor-level outcomes. There is a need to understand the types of survivor-level outcomes the SCPs are likely to change. Informed by existing frameworks and the literature, the objective of this study was to understand the pathways linking the receipt of a SCP to key survivor-level outcomes including patient-centered communication (PCC), health self-efficacy, changes in health behaviors, and improvements in overall health.

METHODS

We used structural equation modeling to test the direct and indirect pathways linking the receipt of an SCP to patient-centered communication (PCC), health self-efficacy, and latent measures of health behaviors and physical health in a nationally representative sample of breast and colorectal cancer survivors from the Health Information National Trends Survey.

RESULTS

The receipt of an SCP did not have a significant effect on key survivor-level outcomes and was removed from the final structural model. The final structural model fit the data adequately well (Chi-square p value = 0.03, RMSEA = 0.07, CFI = .88, and WRMR = 0.73). PCC had a significant direct effect on physical health but not on health behaviors. Health self-efficacy had a significant direct effect on physical health and health behaviors.

CONCLUSION

The receipt of an SCP alone is unlikely to facilitate changes in PCC, health self-efficacy, health behaviors, or physical health.

IMPLICATION FOR CANCER SURVIVORS

A SCP is a single component of a larger model of survivorship care and should be accompanied by ongoing efforts that promote PCC, health self-efficacy, and changes in health behaviors resulting in improvements to physical health.

Prevalence and correlates of adherence to skin examination among adolescent and young adult survivors of melanoma from the Project Forward Study

BACKGROUND

Melanoma is a common cancer among adolescents and young adults (AYAs), yet adherence to recommended surveillance and factors related to adherence are not well understood in this population. This study assessed the prevalence and correlates of physician-conducted skin examination (PSE) and skin self-examination (SSE) among AYA-aged long-term survivors of melanoma.

PROCEDURES

Melanoma cases were identified from the Los Angeles County cancer registry and surveys were then completed by 128 respondents diagnosed between the ages 0 and 24, with stage 1 melanoma or higher, at least 5 years from diagnosis, and who were between the ages 18 and 39 at the time of survey.

RESULTS

Eighty-two percent of AYA melanoma survivors reported SSE within the past 6 months, while 65% reported annual PSE. Greater health care self-efficacy was positively associated with adherence to PSE, SSE, and both types of skin examinations (P < .01). Higher socioeconomic status and having a regular source of primary health care were positively associated with annual PSE and adherence to both surveillance practices (P < .05 and P < .01, respectively). Hispanic ethnicity was negatively associated with annual PSE compared to non-Hispanics (P < .01), and greater depressive symptoms were negatively associated with adherence to both skin examinations (P < .05).

CONCLUSIONS

High rates of SSE were observed, but PSE adherence was lower than optimal in this sample. Interventions to improve PSE are needed for at-risk AYA survivors of melanoma, and strategies that help melanoma survivors navigate the health care system and access primary care may facilitate greater adherence.

Survivorship Care Plans in Cancer: A Meta-Analysis and Systematic Review of Care Plan Outcomes

BACKGROUND

The Institute of Medicine recommends that survivorship care plans (SCPs) be included in cancer survivorship care. Our meta-analysis compares patient-reported outcomes between SCP and no SCP (control) conditions for cancer survivors. Our systematic review examines the feasibility of implementing SCPs from survivors' and health care professionals' perspectives and the impact of SCPs on health care professionals' knowledge and survivorship care provision.

METHODS

We searched seven online databases (inception to April 22, 2018) for articles assessing SCP feasibility and health care professional outcomes. Randomized controlled trials comparing patient-reported outcomes for SCP recipients versus controls were eligible for the meta-analysis. We performed random-effects meta-analyses using pooled standardized mean differences for each patient-reported outcome.

RESULTS

Eight articles were eligible for the meta-analysis (n = 1,286 survivors) and 50 for the systematic review (n = 18,949 survivors; n = 3,739 health care professionals). There were no significant differences between SCP recipients and controls at 6 months postintervention on self-reported cancer and survivorship knowledge, physical functioning, satisfaction with information provision, or self-efficacy or at 12 months on anxiety, cancer-specific distress, depression, or satisfaction with follow-up care. SCPs appear to be acceptable and potentially improve survivors' adherence to medical recommendations and health care professionals' knowledge of survivorship care and late effects.

CONCLUSION

SCPs appear feasible but do not improve survivors' patient-reported outcomes. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues, or inappropriate research design of comparative effectiveness studies.

IMPLICATIONS FOR PRACTICE

Several organizations recommend that cancer survivors receive a survivorship care plan (SCP) after their cancer treatment; however, the impact of SCPs on cancer survivors and health care professionals is unclear. This systematic review suggests that although SCPs appear to be feasible and may improve health care professionals' knowledge of late effects and survivorship care, there is no evidence that SCPs affect cancer survivors' patient-reported outcomes. In order to justify the ongoing implementation of SCPs, additional research should evaluate SCP implementation and the research design of comparative effectiveness studies. Discussion may also be needed regarding the possibility that SCPs are fundamentally ineffective.

The use of mobile technology and peer navigation to promote adolescent and young adult (AYA) cancer survivorship care: results of a randomized controlled trial

PURPOSE

Adolescent and young adult (AYA) cancer survivors experience unique barriers that compromise receipt of survivorship care; therefore, development of innovative educational interventions to improve rates of AYA survivorship care is needed. The efficacy of text-messaging and peer navigation interventions was compared to standard-of-care survivorship educational materials to increase AYAs' (1) late effects knowledge and (2) knowledge, attitudes, and self-efficacy towards seeking survivor-focused care.

METHODS

This was a three-armed, prospective, randomized controlled trial with one control group and two intervention groups. The control group received current standard-of-care educational materials. One intervention group participated in a text-messaging program, and the second participated in a peer navigator program. Participants completed pre- and post-intervention questionnaires. Study outcome variables were quantified using Fisher exact tests, two-sample t tests, exact McNemar tests, conditional logistic regression models, and analysis of covariance.

RESULTS

Seventy-one survivors completed the study (control n = 24; text-messaging n = 23; peer navigation n = 24). Late effects knowledge was high at baseline for all groups. The text-messaging group had increased survivorship care knowledge compared to the control group (p < 0.05); the peer navigation group had increased survivorship care self-efficacy compared to the control group; p < 0.05. Both intervention groups showed increased attitudes towards seeking survivor-focused care compared to the control group (text-messaging p < 0.05; peer navigation p < 0.05).

CONCLUSIONS

Each intervention demonstrated significant benefits compared to the control group.

IMPLICATIONS FOR CANCER SURVIVORS

Given the preliminary effectiveness of both interventions, each can potentially be used in the future by AYA cancer survivors to educate and empower them to obtain needed survivorship care.

Implications for patient-provider communication and health self-efficacy among cancer survivors with multiple chronic conditions: results from the Health Information National Trends Survey

PURPOSE

Cancer survivors with multiple chronic conditions experience significant challenges managing their health. The six core functions of patient-centered communication (PCC)-fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management-represent a central component to facilitating a survivor's confidence to manage their health that has not been investigated in cancer survivors with multiple chronic conditions.

METHOD

Nationally representative data across two iterations of the Health Information National Trends Survey (HINTS) were merged with combined replicate weights using the jackknife replication method. Adjusted linear regression examined the association between PCC and health self-efficacy in a sample of breast, colorectal, and prostate cancer survivors and by multiple chronic conditions.

RESULTS

53.9% reported that providers did not always respond to their emotions and 48.9% reported that they could not always rely on their providers to help them manage uncertainty. In the adjusted linear regression models, there was a significant positive association between PCC and health self-efficacy (β = 0.2, p = 0.01) for the entire sample. However, the association between PCC and health self-efficacy was attenuated in cancer survivors with multiple chronic conditions (β = 0.1, p = 0.53).

CONCLUSION

PCC alone is not enough to improve a cancer survivor's confidence in their ability to manage their health in the presence of multiple chronic conditions.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors with multiple chronic conditions need ongoing support, in addition to PCC, that render them prepared to manage their health after cancer.

Tailored education enhances healthy behaviour self-efficacy in childhood cancer survivors: A randomised controlled study with a 4-month follow-up

This study was to evaluate the acceptability and effectiveness of a tailored education on healthy behaviour self-efficacy (HBSE) and health promotion lifestyle (HPL) for childhood cancer survivors. A two-group, randomised study with repeated measures was conducted in Taiwan. Participants were randomly assigned to receive six 45-60 min individual education and follow-up telephone counselling sessions (n = 34) or standard of care only (n = 35). Each participant was assessed with HBSE and HPL questionnaires and was evaluated at three time points (at baseline, and then 1 and 4 months after intervention). The attrition rate was 7.2%. HBSE and HPL scores increased across the three time points in the experimental group (all p < 0.05), except for the HBSE exercise subscale (p = 0.85). HBSE scores were significantly higher for the experimental group than for the control group after 4 months of intervention (F = 5.32, p = 0.02, η²  = 0.25). No significant improvements in HBSE were observed over time in the control group. The intervention was acceptable and effective in promoting HBSE in childhood cancer survivors. Further empirical work is needed to reveal the effects of the intervention over a longer period of time and to improve patient engagement in exercise.

Iterative Development of a Tailored mHealth Intervention for Adolescent and Young Adult Survivors of Childhood Cancer

Objectives

Methods for developing mobile health (mHealth) interventions are not well described. To guide the development of future mHealth interventions, we describe the application of the agile science framework to iteratively develop a mHealth intervention for adolescent and young adult (AYA) survivors of childhood cancer.

Methods

We created the AYA STEPS mobile app (AYA Self-management via Texting, Education, and Plans for Survivorship) by modifying and integrating two existing programs: an online survivorship care plan (SCP) generator and a text messaging self-management intervention for AYA off treatment. The iterative development process involved three stages of agile science: 1) Formative work, 2) Obtaining feedback about the first AYA STEPS prototype, and 3) Pilot testing and finalization of a prototype. We determined preferences of AYA stakeholders as well as discovered and addressed technology problems prior to beginning a subsequent randomized controlled trial.

Results

AYA survivors reported that the app and the embedded tailored messages related to their health and SCP, were easy to use and generally satisfying and beneficial. Usage data supported that AYA were engaged in the app. Technology glitches were discovered in the pilot and addressed.

Conclusions

The iterative development of AYA STEPS was essential for creating a consistent and acceptable end user experience. This study serves as one example of how behavioral scientists may apply agile science to their own mHealth research.

Long-term complications in adolescent and young adult leukemia survivors

Adolescents and young adults (AYAs) with cancer, defined by the National Cancer Institute as having been diagnosed between the ages of 15 and 39 years old, have not benefited from the same improvements in quality of outcomes and survival that have been seen for individuals diagnosed in childhood or as older adults. Although is leukemia composed of a diverse group of diagnoses, leukemia AYA survivors share unique vulnerabilities with other AYA diagnostic groups. They will spend the majority of their lives as survivors, with clear evidence of adverse medical conditions, health care requirements, and social and psychological needs that differ not only from their peers but also, from the needs of other cancer survivor populations. Furthermore, they share a developmental stage of life in which careers, finances, and family concerns are uniquely impacted by the cancer diagnosis and treatment. Leukemia in AYAs typically presents with higher-risk biologic features, and treatment requires multiagent chemotherapy, including alkylating agents, anthracyclines, high-dose steroids, frequently intrathecal chemotherapy, and sometimes, cranial radiation. Thus, AYAs have significant risks for long-term complications, subsequent malignancies, and accelerated development of usual age-related comorbid conditions, such as cardiovascular disease and dyslipidemias. AYAs require specialized health care monitoring, surveillance for late effects, and periodic evaluation of psychosocial, health behavior, and life goal outcomes.

Survivorship Care Planning for Young Adults After Cancer Treatment: Understanding Care Patterns and Patient-Reported Outcomes

PURPOSE

Young adult survivors (YAS) of cancer experience late effects of treatment similar to older adult survivors (AS). Online health tools such as Internet-based survivorship care plans (SCPs) can provide access to information about late effects and symptom management, but little is known about SCP patterns of use among YAS.

METHODS

An Internet-based cross-sectional survey was completed over 24 months. Participants were individuals diagnosed with cancer between 18 and 39 years (YAS, n = 611) or 40-60 years (AS, n = 1742), who were 2-20 years postdiagnosis, and who created an Internet-based SCP. Demographics, treatment-related variables, satisfaction with SCP, communication of SCP, and patient-reported late effects (fatigue, neurocognitive, sexual, cardiovascular, pulmonary, or second cancers) were collected.

RESULTS

YAS were primarily female (71%), Caucasian (78%), college educated (65%), and generated the SCP without assistance (76%). YAS reported satisfaction with content (93%) and shared content with providers (71%). A higher proportion of YAS than AS were male (29% vs. 17%, p < 0.001), lived internationally (23% vs. 17%, p = 0.003), and endorsed oncologist-led survivorship care (47% vs. 41%, p = 0.001). YAS reported concerns about neurocognitive performance (56%) and fatigue (50%). Overall, YAS reported equivalent or fewer late effects than AS across all domains.

CONCLUSIONS

YAS report high satisfaction with the online SCP, as well as a high symptom burden, although the latter were reported less than for AS.

Patient-centered communication between adolescent and young adult cancer survivors and their healthcare providers: Identifying research gaps with a scoping review

OBJECTIVE

To conduct a scoping literature review to identify practices or programs that promote AYA patient-centered communication.

METHODS

Between January and May of 2016, we applied standard scoping review methodology to systematically review articles. We considered peer-reviewed, English language articles written at any phase of intervention research. Both qualitative and quantitative studies were eligible, and no additional search restrictions were applied. We retained articles that included explicit or implicit outcomes for one of the six functions of patient-centered communication in cancer care. At least two independent reviewers assessed the articles.

RESULTS

We screened a total of 4072 titles and abstracts, retaining 27 for full-text review. Ultimately, eight titles met the review's inclusion criteria. We categorized each publication by the action or setting used to improve patient-centered communication, resulting in five categories. Most studies were not included because they did not include a patient-centered communication outcome.

CONCLUSION

This area of research is still emerging, as indicated by the small number of eligible studies and predominance of qualitative, descriptive, pilot, and feasibility studies with small sample sizes.

PRACTICE IMPLICATIONS

Our results suggest a clear need to develop and evaluate interventions focused on improving patient-centered communication between AYA survivors and their healthcare providers.

Follow-Up Care Provider Preferences of Adolescent and Young Adult Cancer Survivors

PURPOSE

To explore the experiences and perspectives of adolescent and young adult (AYA) cancer survivors regarding patient-provider relationships and their preferences surrounding type of healthcare provider for follow-up care.

METHODS

We recruited AYA cancer survivors who were diagnosed between the ages of 15 and 39 using the Utah Cancer Registry. Twenty-eight survivors participated in six focus groups held between March and May of 2015 in Salt Lake City and St. George, Utah. This analysis focuses on how survivors' preferences about type of healthcare provider may influence their transition into, and utilization of, follow-up care.

RESULTS

On average, survivors were 6.3 (standard deviation = 1.7) years from their cancer diagnosis. A majority of survivors expressed a desire not to transition to a new provider and preferred continuing to see their oncologist for follow-up care. For these survivors, this was due to already having a close relationship with their oncologist and because they trusted their provider's knowledge about cancer and how to handle late effects. However, survivors placed emphasis on being comfortable with their healthcare provider, regardless of provider type.

CONCLUSIONS

Our findings demonstrate the importance of formalizing provider transitions and roles after cancer therapy to improve patient comfort with new providers. By understanding the complexities of the transition from active cancer treatment to follow-up care for AYA survivors, these findings can inform programs undertaking post-care educational activities to ensure a seamless transition into survivorship care. Survivorship care plans can facilitate these transitions and improve patient confidence in follow-up care.

Supporting long-term follow-up of young adult survivors of childhood cancer: Correlates of healthcare self-efficacy

BACKGROUND

Healthcare self-efficacy (HCSE), the perceived confidence to manage one's health care, has been identified as a critical component in the transition process from pediatric to adult-oriented care for childhood cancer survivors (CCSs). HCSE is amenable to intervention and associated with long-term follow-up care among CCSs. However, factors associated with HCSE have not been fully explored among CCSs.

PROCEDURE

We identified correlates of HCSE among a sample of CCSs (n = 193). Descriptive statistics and linear regression methods were used in this cross-sectional analysis.

RESULTS

In univariate analyses, higher physical and psychosocial quality of life, posttraumatic growth, and religious/spiritual importance were associated with higher HCSE. Attendance at a survivorship clinic, having a regular source of care (both noncancer and oncologist), and any type of health insurance were also associated with HCSE. Hispanic ethnicity was negatively associated with HCSE relative to non-Hispanics. In a multivariable model, psychosocial quality of life, religious/spiritual importance, survivorship clinic attendance, having a regular oncologist, and Hispanic ethnicity remained significantly associated with HCSE.

CONCLUSIONS

CCSs who reported greater well-being, who rated religion and spirituality of high importance, and who accessed specialized cancer services expressed greater HCSE. Hispanic CCSs, however, reported less HCSE than non-Hispanics. Interventions that attend to the quality of life and spiritual needs of CCSs have potential to build HCSE to support the healthcare transition process. Because Hispanic CCSs may be at risk of lower perceived confidence to navigate their health care, culturally competent, efficacy-enhancing interventions are needed for this population.

Quality of Patient-Provider Communication Among Cancer Survivors: Findings From a Nationally Representative Sample

PURPOSE

Although patient-provider communication is an essential component of health care delivery, little is known about the quality of these discussions among patients with cancer.

METHODS

Data are from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey among 1,202 adult cancer survivors. We evaluated discussions with any provider after a cancer diagnosis about: (1) follow-up care; (2) late or long-term treatment effects; (3) lifestyle recommendations, such as diet, exercise, and quitting smoking; and (4) emotional or social needs. Using a response scale ranging from "did not discuss" to "discussed in detail," a summary score was constructed to define communication quality as high, medium, or low. Patient factors associated with the quality of provider discussions were examined using multivariable polytomous logistic regression analyses.

RESULTS

At the time of the survey, approximately one half of the patients (46%) were either within 1 year (24.1%) or between 1 and 5 years (22.0%) of treatment. More than one third of cancer survivors reported that they did not receive detailed communication about follow-up care, and more than one half reported that they did not receive detailed communication regarding late or long-term effects, lifestyle recommendations, or emotional and social needs. Only 24% reported high-quality communication for all four elements, indicating that the vast majority experienced suboptimal communication. In multivariable analysis, survivors reporting a high communication quality with providers included those who were within 1 year of treatment, between the ages of 18 and 64 years, non-Hispanic black or other ethnicity, and married.

CONCLUSION

Study findings demonstrate gaps in the communication quality experienced by cancer survivors in the United States and help identify survivors for targeted interventions.

Factors influencing implementation of a survivorship care plan-a quantitative process evaluation of the ROGY Care trial

Purpose

The aim of this study is to investigate the factors that influence implementation of Survivorship Care Plans (SCPs) in the intervention arm of the ROGY Care trial by (1) assessing the level of SCP receipt in the ROGY Care trial and (2) identifying patient- and provider-level factors that influence SCP receipt.

Methods

Between 2011 and 2015, a pragmatic cluster randomized-controlled-trial was conducted on the effects of automatically generated SCPs. Endometrial (N = 117) and ovarian (N = 61) cancer patients were allocated to ‘SCP care’, as provided by their SCP care providers (N = 10). Associations between SCP receipt (self-reported SCP receipt and actually generated SCPs), patient-factors (socio-demographic-, clinical-, and personality factors), and care provider factors (profession and a-priori motivation regarding SCP provision) were tested in univariate analysis. The odds ratios of factors influencing self-reported SCP receipt were estimated with a multivariate regression model.

Results

Of all patients in the SCP care arm (N = 178), SCPs were generated by the care provider for 90 % of the patients and 70 % of the patients reported that they had received an SCP. Patients with older age, ovarian cancer, type D (distressed) personality, and patients that completed the questionnaire a longer period of time after the SCP consult were more likely to report no SCP receipt.

Conclusions

SCP receipt was influenced by patient- but not care-provider factors.

Implications for cancer survivors

Certain patient groups were less likely to report SCP receipt. Whether all patients are in need of an SCP, requires further investigation. If they do, more efforts need to be made towards the implementation of SCPs.

Depression in adolescents and young adults with cancer

Adolescents and young adults (AYAs) with cancer are at risk for depression due to disruptions in their developmental trajectory, greater physical symptom burden, and increased likelihood of developing aggressive disease. Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults. Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression. Previous research suggests that psychosocial interventions specifically designed for AYA patients are promising, but studies of psychopharmacology treatments for depression are lacking. There is a pressing need for prospective studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group.

An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans

Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.

Identifying Predictors of Longitudinal Decline in the Level of Medical Care Received by Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study

OBJECTIVES

Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer.

DATA SOURCES

The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer.

STUDY DESIGN

Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care.

DATA COLLECTION

There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up.

PRINCIPAL FINDINGS

Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤ high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for

CONCLUSIONS

While the incidence of late effects increases over time for survivors, the likelihood of receiving survivor-focused care decreases for vulnerable populations.

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Key Words

• Childhood cancer survivors
• delivery of health care
• health care access
• health insurance
• survivorship

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MESH Headings

• Adolescent
• Adult
• Age Factors
• Female
• Health Services/statistics & numerical data
• Health Status
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Neoplasms/epidemiology
• Neoplasms/therapy
• Retrospective Studies
• Sex Factors
• Socioeconomic Factors
• Survivors/statistics & numerical data
• Young Adult

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Grants

• U24 CA055727 NCI NIH HHS
• CA21765 NCI NIH HHS
• P30 CA008748 NCI NIH HHS
• P30 CA021765 NCI NIH HHS
• CA55727 NCI NIH HHS

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Affiliation(s)

Jacqueline Casillas Address correspondence to Jacqueline Casillas, M.D., M.S.H.S., Department of Pediatrics, University of California, 10833 Le Conte Ave. Room A2-312 MDCC, Los Angeles, CA 90095; e-mail:
Kevin C Oeffinger Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Melissa M Hudson Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Mark L Greenberg Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Mark W Yeazel Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Kirsten K Ness Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Tara O Henderson Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Leslie L Robison Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Gregory T Armstrong Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Qi Liu Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Wendy Leisenring Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Yutaka Yasui Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA
Paul C Nathan Kevin C. Oeffinger, M.D., is with the Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY Melissa M. Hudson, M.D., and Gregory T. Armstrong, M.D., are with the Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Mark L. Greenberg, M.B., Ch.B., F.R.C.P.C., F.A.A.P., and Paul C. Nathan, M.D., M.Sc., are with the Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada Mark W. Yeazel, M.D., M.P.H., is with the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN Kirsten K. Ness, P.T., Ph.D., and Leslie L. Robison, Ph.D., are with the Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN Tara O. Henderson, M.D., is with The University of Chicago Medicine Comer Children's Hospital, Chicago, IL Qi Liu, M.S., and Yutaka Yasui, Ph.D., are with the Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada Wendy Leisenring, Sc.D., is with the Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA

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Depression in adolescents and young adults with cancer

Adolescents and young adults (AYAs) with cancer are at risk for depression due to disruptions in their developmental trajectory, greater physical symptom burden, and increased likelihood of developing aggressive disease. Rates of depression and other psychological disorders are substantially higher in AYAs with cancer when compared with older adults. Psychiatrists caring for these patients must consider the age-appropriate developmental context of these patients along with familial and medical factors that may influence the presentation and treatment of depression. Previous research suggests that psychosocial interventions specifically designed for AYA patients are promising, but studies of psychopharmacology treatments for depression are lacking. There is a pressing need for prospective studies and controlled clinical trials that evaluate the optimal strategies for treating depression in this patient group.

Summing it up: an integrative review of studies of cancer survivorship care plans (2006-2013)

In 2006, the Institute of Medicine recommended that cancer survivors who are completing primary treatment receive a survivorship care plan (SCP) based on face validity. The state of scientific knowledge regarding the SCP is unclear. The authors conducted an integrative review of existing evidence regarding SCPs. The MEDLINE/PubMed database, the Excerpta Medica Database (EMBASE), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched for relevant studies published between 2006 and 2013 using a combination of keywords: "survivors," "survivorship," "care plans," "care planning," "treatment summaries," and "cancer." Articles were included if they 1) reported results from an empirical study, 2) included cancer survivors who were diagnosed at age ≥ 18 years, 3) related to SCP, and 4) were published in English. In total, 781 records were retrieved; 77 were identified as duplicates, and 665 were abstracts or presentations that did not relate to SCPs for adults or were not empirical, which left 42 articles for inclusion in this review. Studies regarding SCP fell into 3 categories: 1) content (n=14), 2) dissemination and implementation (n=14), and 3) survivor and provider outcomes (n=14). SCPs have been endorsed and are associated with improved knowledge, but SCP use remains sporadic. Only 4 studies were randomized controlled trials (RCTs) that avoided many biases associated with observational studies. Other limitations included cross-sectional or pre-SCP-post-SCP ("pre-post") designs, limited generalizability caused by a lack of sample diversity, and a lack of systematic testing of data-collection tools. The quantity and quality of SCP research are limited. SCPs have been endorsed, but evidence of improved outcomes associated with SCP is limited. Future research that addresses the methodological concerns of extant studies is needed regarding SCP use, content, and outcomes.

Survivorship care planning and its influence on long-term patient-reported outcomes among colorectal and lung cancer survivors: the CanCORS disease-free survivor follow-up study

PURPOSE

This study aims to evaluate the relationship between survivorship care planning (SCP) and survivorship care and health outcomes reported by long-term lung and colorectal cancer survivors.

METHODS

Participants (n = 832) were diagnosed and enrolled during 2003-2005. In 2012, patient-reported outcomes (survivorship care and health outcomes) and two patient-reported SCP measures (receipt of written summary of cancer treatment and receipt of instructions on who to see for routine cancer follow-up) were collected. Analyses controlled for SCP predictors collected from medical records and an interview 1 year after diagnosis.

RESULTS

One in four survivors reported receiving both SCP elements. Those receiving both were more certain which doctor was in charge (odds ratio (OR) 7.0; 95 % confidence intervals (95 % CI) 3.9-12.5), more likely to report follow-up checkup (OR 5.1; 95 % CI 3.3-8.0), and had an MRI/PET/CT scan in the past 2 years (OR 2.8; 95 % CI 1.7-4.7) compared to those receiving neither. Physician communication experiences were significantly more positive and having physical exams (OR 2.0; 95 % CI 1.2-3.4) and meeting exercise guidelines (OR 1.6; 95 % CI 1.004-2.4) more likely. Physical health (p = 0.012) and good-to-excellent self-perceived health status (OR 2.2; 95 % CI 1.3-3.9) were better for those receiving both elements.

CONCLUSION

SCP may lead to better cancer follow-up care, long-term physical health, and physician-patient communication experiences.

IMPLICATIONS FOR CANCER SURVIVORS

The positive association between outcomes and SCP suggests that efforts to implement SCP should be fruitful.

Models of Cancer Survivorship Care: Overview and Summary of Current Evidence

INTRODUCTION

This article, derived from a Technical Brief prepared for the Agency for Healthcare Research and Quality, presents an overview on current models of care for survivors of adult-onset cancer who have completed active treatment.

METHODS

This article integrates reviewed literature on background, context, research gaps, and future research directions for survivorship care models. We also conducted a systematic literature review of current evidence from studies of survivorship care models.

RESULTS

Our systematic review identified nine empirical studies of survivorship care models, covering multiple models types and illustrating the heterogeneity in this field. The literature review indicated considerable heterogeneity in models of survivorship care, components of models, survivor populations, and target outcomes. Models of survivorship care are highly individualized to the institution or setting where they are provided. "Usual care" is often uncoordinated and highly varied across cancer survivors and within cancer programs. Anticipated shortages in the oncology workforce may require the expanded use of nurse practitioners and physician assistants and shared care with primary care providers to deliver survivorship care to the growing number of survivors. Concerns associated with survivorship care models include payment considerations, adequacy of training, and the potential for lack of coordination and fragmented care.

CONCLUSION

There is substantial variation in survivorship care models. The optimal nature, timing, intensity, format, and outcomes of survivorship care models are uncertain and require further research. Specific research questions need to be addressed by the survivorship community to better understand the advantages and limitations of survivorship models.

Meeting reality: young adult cancer survivors' experiences of reentering everyday life after cancer treatment

BACKGROUND

Cancer in young adults is rare, but the intensity of cancer treatment increases the risk of physical and psychosocial impacts on patients' entire lives. Young adult survivors are underrepresented in research, and knowledge of cancer survivors in this age group is scarce, especially knowledge of transition from cancer treatment to everyday life.

OBJECTIVE

The objective of this study was to explore how young adult cancer survivors experience reentering everyday life after cancer treatment.

METHODS

A qualitative, phenomenological approach was used and included 20 young adult survivors (aged 24-35 years) with different cancer diagnoses allocated to a rehabilitation program. Semistructured interviews were conducted, and the transcripts were analyzed qualitatively using Systematic Text Condensation method.

RESULTS

"Meeting reality" was identified as a bridging theme, explained by 4 main themes important to the informants: (1) lack of preparation, (2) late effects, (3) lack of understanding, and (4) being neither sick nor healthy.

CONCLUSIONS

Informants were unprepared for reentering everyday life after cancer treatment and experienced a mismatch of their expectations with reality, particularly in the holistic impact of late effects. Moreover, reentering everyday life was characterized by a lack of understanding from their network and even healthcare providers who conducted follow-ups. The informants experienced reentering everyday life as being much harder than expected, and they felt isolated as well as neither sick nor healthy.

IMPLICATIONS FOR PRACTICE

The results suggest a major shortcoming in both preparation for survivorship, multidisciplinary follow-ups, and knowledge. A shift to a more holistic perspective in survivorship care is suggested.

Physical, emotional, and social health differences between posttreatment young adults with cancer and matched healthy controls

BACKGROUND

Young adults (YAs; ages 18-39 years) with cancer face interrupted developmental milestones and increased stressors that can adversely influence psychosocial adjustment. Transitioning from active treatment to posttreatment survivorship can be particularly challenging. The purpose of this study is to describe the health-related quality of life (HRQL) and psychological adaptation of YAs after treatment, relative to young adults without cancer.

METHODS

Three cohorts of YAs of mixed cancer diagnoses (N = 120, 0-12 months after treatment; N = 102, 13-24 months after treatment; and N = 113, 25-60 months after treatment; combined M = 31.8 years old, combined sex = 68% women) and an age-, education-, sex-, and partner status-matched group of healthy control participants (HCs; N = 335) were recruited via an online research panel. All participants completed measures assessing demographic and clinical characteristics, HRQL (physical, emotional, social, and spiritual), and psychological adaptation (anxiety, depression, positive affect, posttraumatic growth). Measure content was slightly modified for applicability to HCs without a cancer history.

RESULTS

Multivariate analysis of covariance found a significant main effect for group (YAs versus HCs) and a significant group-by-cohort interaction. YAs reported poorer physical (P = .005, d = .22) and emotional well-being (P = .011, d = .20) but better social well-being (P < .001, d = .49). YAs reported comparatively stable scores (P = .74) for posttraumatic growth compared to HCs, who reported greater posttraumatic growth across cohorts (P = .01, d = 16).

CONCLUSIONS

Findings underscore the negative and positive sequelae for YAs and highlight the need for comprehensive assessment among YA survivors of cancer. A matched, HC group allows the HRQL and psychological adaptation of YAs to be placed in context, enabling a more precise determination of the impact of cancer on YAs.

Are Current Care Models Meeting the Psychosocial Needs of Adolescent and Young Adult Cancer Survivors? A Literature Review

BACKGROUND

Adolescents and young adults diagnosed with cancer are expected to become long-term survivors. A cancer diagnosis during this critical life stage can have a profound impact on normal psychosocial development, increasing risk for adverse long-term and late effects and influencing quality of life.

PURPOSE

The purpose of this article was to review the impact of cancer on some key psychosocial aspects of adolescent and young adult cancer survivors, including the impact of a cancer diagnosis on psychosocial development, the effectiveness of current models of care in relation to addressing the psychosocial needs of this patient population, and the evaluation of current Canadian models of care and implications for clinical practice.

METHODS

A review of the English literature from 2002 to 2012 was performed using PubMed (National Center for Biotechnology Information), Ovid MEDLINE, and Google Scholar.

RESULTS AND CONCLUSIONS

Various survivorship care models have been implemented to assist adolescent and young adult cancer survivors in addressing the psychosocial issues associated with a cancer diagnosis, although the type of model used varies based on institutional resources and survivors' needs. Preliminary survivorship research identifies the need for long-term follow-up care including ongoing assessment for psychosocial issues. The literature also identifies the need to educate adolescents and young adults regarding their disease, which will empower these patients to act as their own health care advocates, resulting in improved health-related outcomes and overall quality of life. However, despite the increasing focus on the benefits of good survivorship care and the availability of government-funded survivorship programs in Canada, programs are often underused by this patient population. Survivorship care is a new focus for research that requires more evaluation regarding the feasibility and effectiveness of the different care models in meeting the psychosocial needs of adolescent and young adult cancer survivors.

Health promotion in adolescent and young adult cancer survivors: mobilizing compliance in a multifaceted risk profile

With rising cure rates of childhood cancer, nurse practitioners have an increased chance of encountering a large survivor cohort in practice. A variety of late effects programs exist; however, funding is limited for these programs and is not accessible for all patients. Primary providers may increasingly act as a medical home for childhood cancer survivors (CCS). Understanding the inherent risks of cytotoxic treatment and the progressive consequences of late effects is vital to limit morbidity and mortality. Adolescent and young adult survivors (AYA) are particularly apt to make health behavior decisions that create risks for comorbidities. Developmentally appropriate experimentation with drug, alcohol, or tobacco use and increased ultraviolet ray exposure intensifies the risk for secondary malignancies and novel diseases. The paucity of evidence-based surveillance guidelines and survivor-specific health promotion programs cumulatively widen the gap in noncompliance and misinformation. This article overviews the risk profile of CCS. It explores health practices, as well as emerging health promotion techniques, within the AYA survivor population and the role nurse practitioners have in enhancing health maintenance.

Perspectives of a lifelong cancer survivor--improving survivorship care

Many of the 14 million cancer survivors in the USA live with physical, emotional and day-to-day concerns related to their cancer long after their treatment ends. Addressing the needs of the growing cancer-survivor population will be a considerable task. In this article, Ruth Rechis--a 20-year survivor of Hodgkin lymphoma--describes her personal account of surviving cancer and her experience as a researcher and advocate in the field of survivorship. Results from a national USA survey on survivorship are shared, illustrating gaps in meeting the needs of long-term survivors. A list of 'essential elements' of survivorship care is highlighted to introduce all practitioners to the components necessary for the provision of care after treatment ends. Finally, Rechis provides recommendations for engaging survivors as active participants in their post-treatment, long-term survivorship care and to ensure appropriate care is universally available as part of patient-centred comprehensive care.

Survivorship care planning in colorectal cancer: feedback from survivors & providers

The Institute of Medicine recommended that all patients receive survivorship care plans (SCPs) post-treatment to improve quality of follow-up care. However, little is known regarding how survivors utilize SCPs and the congruency between providers' and survivors' perspectives. Feedback from colorectal cancer survivors (in receipt of a personalized/individualized SCP) and oncology providers was obtained via interviews. Survivors noted SCPs benefits of reduced duplicative procedures and cancer worry with the synthesized treatment information. Providers noted billing/reimbursement and time investiture (for form completion) as potential barriers. Further investigation of SCPs is warranted regarding utility prior to widespread adoption in follow-up care.