Treatment refusal in adolescents

Adolescent Adherence to Oral Therapy for Leukemia: A Focus Group Study

This secondary qualitative analysis of extant focus group data was performed to develop an understanding of suboptimal adherence to 6-mercaptopurine therapy in adolescents with acute lymphoblastic leukemia. Six participants, aged 16 to 23 years at the time of data collection, were interviewed about their adherence to oral maintenance chemotherapy during their treatment for acute lymphoblastic leukemia. The primary aim of the study was to understand the role of adolescent development in adolescents' perception of adherence to therapy. The secondary aim was to understand how factors other than development, including the features of the disease such as its chronic nature and family involvement, can affect treatment adherence to 6-mercaptopurine. Four broad themes emerged as critical elements in adolescent adherence to oral maintenance therapy: a desire for normalcy, egocentrism, concrete thinking, and parental involvement. Incorporation of these themes into clinical practice with adolescents may help increase adherence and improve clinical outcomes.

Treatment non-adherence in teenage and young adult patients with cancer

Adhering to treatment can be a significant issue for many patients diagnosed with chronic health conditions and this has been reported to be greater during the adolescent years. However, little is known about treatment adherence in teenage and young adult (TYA) patients with cancer. To increase awareness of the adherence challenges faced by these patients, we have reviewed the published work. The available evidence suggests that a substantial proportion of TYA patients with cancer do have difficulties, with reports that up to 63% of patients do not adhere to their treatment regimens. However, with inconsistent findings across studies, the true extent of non-adherence for these young patients is still unclear. Furthermore, it is apparent that there are many components of the cancer treatment regimen that have yet to be assessed in relation to patient adherence. Factors that have been shown to affect treatment adherence in TYA patients include patient emotional functioning (depression and self-esteem), patient health beliefs (perceived illness severity and vulnerability), and family environment (parental support and parent-child concordance). Strategies that foster greater patient adherence are also identified. These strategies are multifactorial, targeting not only the patient, but the health professional, family, and treatment regimen. This review highlights the lack of interventional studies addressing treatment adherence in TYA patients with cancer, with only one such intervention being identified: a video game intervention focusing on behavioural issues related to cancer treatment and care. Methodological issues in measuring adherence are addressed and suggestions for improving the design of future adherence studies highlighted, of which there is a great need.

An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer

The demands of cancer treatment are particularly challenging for newly diagnosed adolescents. If attempts to cope with these demands are unsuccessful, adolescents may not comply with or may refuse treatment. As a result, their chances of survival are decreased. The purpose of this study, guided by the Adolescent Self-Sustaining Model, was to determine the effects of a three-part educational intervention designed to facilitate copying on psychological (hopefulness, hopelessness, self-esteem, self-efficacy and symptom distress) and clinical outcomes (treatment toxicity) among adolescents newly diagnosed with cancer. This two-site study used a longitudinal experimental two-group design with adolescents randomly assigned to the intervention or control group. Four measurement points spanning the first 6 months of treatment were included in the design. Of 93 eligible adolescents, 78 (46 females and 32 males) agreed to participate. No statistically significant differences between the intervention and control groups, or between male and female participants, were detected at any measurement point. Differences in scores over time within groups were noted. Explanations for the lack of group differences are offered, as are recommendations for strengthening the intervention and design for future testing.

Health behaviors of adolescents who have been diagnosed with cancer

Many challenges related to the development and diagnosis of cancer are faced by adolescents with the disease. Adolescence is a developmental period for behaviors that risk health. The article describes behaviors that promote and risk health among adolescents who have been diagnosed with cancer. A paucity of studies exists on health-promoting and -risking behaviors among adolescents with cancer. Further studies are needed to explore and describe these adolescents' health-promoting and -risking behaviors. Health care professionals must comprehensively address these adolescents' health care needs related to the diagnosis of cancer as well as the developmental challenges of adolescence.

Cancer patients who refuse treatment

The value of cancer treatment was assessed using a 'natural experiment' where patients who refused treatment served as no-treatment controls in a situation where withholding treatment to form a control group is unethical. Each cancer patient who refused treatment in Alberta, Canada between 1975 and 1988 was compared with five subjects who accepted treatment, matched on cancer site, age, number of cancers, and time period. Variables associated with treatment-refusal were included in Cox's proportional hazards model of survival, with death from cancer as the endpoint and deaths from other causes as censored observations. Treatment was refused at a rate of 7.5 per 1,000. One-third of patients who refused treatment had lung cancer and most had unstaged disease. Treatment refusal was associated with a difference in median survival of approximately nine months. Site-specific analyses showed a range of effects. Case fatality among the treated patients fell by approximately 10 percent during the 14-year study period. Even in advanced disease, treatment can result in improved survival. However, the results of this study must be interpreted with caution and cannot be generalized to all cancer patients.