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Stenmarker M, Björk M, Golsäter M, Enskär K. Everyday life during the childhood cancer trajectory-childhood cancer survivors' descriptions of the role of caring support. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1098933. [PMID: 37397267 PMCID: PMC10313101 DOI: 10.3389/fresc.2023.1098933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
Background Being diagnosed with cancer in childhood often has a direct impact on the child's opportunities to participate in activities and the child's sense of belonging in different life situations. Experiences of illness in youth affect the lives of these individuals in numerous ways and they need pronounced support to regain their normal life after treatment. Purpose To illustrate how childhood cancer survivors describe the role of the caring support provided by healthcare professionals at diagnosis and during the cancer trajectory. Methods A mixed methods approach was applied. Swanson's Theory of Caring was used to deductively analyze the answers in a study-specific questionnaire with Likert scales (1-5). Descriptive and comparative statistics and exploratory factor analyses were performed. Results Sixty-two former patients, diagnosed with solid tumors/lymphoma in 1983 to 2003 in Sweden, participated. The mean time passed since treatment was 15.7 years. Swanson's caring processes Being with and Doing for were the most prominent loading categorical factor indicators. Higher scores for healthcare professionals being emotionally present (Being with), doing for others what they would do for themselves (Doing for) and being willing to understand the sick child's situation (Knowing) were highlighted by survivors older than 30 years, compared to those younger than 30 years (p = 0.041, p = 0.045, and p = 0.013, respectively). An increased vulnerability regarding their ability to cope with difficulties (Maintain belief) was found among participants who were treated during adolescence, related to schoolchildren (p = 0.048), and among those who had been treated with extra-cranial irradiation in comparison with no extra-cranial irradiation (p = 0.004). The role of having a partner in comparison with being single was underlined among those who felt they had acquired the tools they needed to take care of themselves (Enabling) (p = 0.013). The total explained variance was 63%. Conclusions A person-centered care approach during treatment for childhood cancer, reflected by a caring model, highlights the role of healthcare professionals being emotionally present, involving children, performing actions, and with an approach that has potential long-term implications. Childhood cancer patients and survivors need not only clinically competent professionals, but professionals who provide caring interactions with compassion.
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Affiliation(s)
- Margaretha Stenmarker
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Jönköping County, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Björk
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- CHILD—Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marie Golsäter
- CHILD—Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Child Health Services, Region Jönköping County, Jönköping, Sweden
| | - Karin Enskär
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Miyagishima K, Ichie K, Sakaguchi K, Kato Y. The process of becoming independent while balancing health management and social life in adolescent and young adult childhood cancer survivors. Jpn J Nurs Sci 2023:e12527. [PMID: 36772871 DOI: 10.1111/jjns.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/01/2022] [Accepted: 01/12/2023] [Indexed: 02/12/2023]
Abstract
AIM This study aimed to elucidate the process of how adolescent and young adult childhood cancer survivors (CCSs) become independent while balancing health management and social life with a view to providing long-term support. METHODS Semi-structured interviews were conducted with 22 Japanese CCSs aged 16-25 years. The data were then qualitatively analysed using the modified grounded theory approach. RESULTS Seven "categories" and 35 "concepts" were generated. The connections among these categories and concepts revealed the process of becoming independent while balancing health management and social life. The first phase in the process is "coordination within constraints," which includes "consciousness and worries about deteriorating health" and "adjustments to balance schoolwork and treatment." This phase changes into "challenges to being free and normal" and "release from constraints." Psychological development then occurs as "gratitude toward surrounding people" and "sustenance from experiencing a rare illness." However, CCSs also "face worries about the persistent effects of cancer," including "awareness of the necessity to continue hospital visits even into adulthood." Through these experiences, CCSs reach the phase of "finding a way to live with oneself," which integrates health management with social life. CONCLUSIONS These findings may help parents and health, education, and social-care professionals anticipate and share changes in CCSs physical condition, daily life, and psychosocial development. CCSs need support in terms of coordinating cancer therapy and school life, trying what they want to do, self-managing their own health condition, and forming their identity, including making sense of their illness experience.
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Affiliation(s)
- Kyoko Miyagishima
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuko Ichie
- Faculty of Nursing, Seirei Christopher University, Hamamatsu, Japan
| | | | - Yuka Kato
- Department of Nursing, Shizuoka Children's Hospital, Shizuoka, Japan
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Risk stratification of young adult survivors of cancer to estimate hospital morbidity burden: applicability of a pediatric therapy-based approach. J Cancer Surviv 2020; 15:452-460. [PMID: 32939686 PMCID: PMC8134299 DOI: 10.1007/s11764-020-00939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/05/2020] [Indexed: 11/05/2022]
Abstract
Purpose Children and young adults (CYA) are at risk of late morbidity following cancer treatment, with risk varying by disease type and treatment received. Risk-stratified levels of aftercare which stratify morbidity burden to inform the intensity of long-term follow-up care, are well established for survivors of cancer under the age of 18 years, utilizing the National Cancer Survivor Initiative (NCSI) approach. We investigated the applicability of risk-stratified levels of aftercare in predicting long-term morbidity in young adults (YA), aged 18–29 years. Methods Long-term CYA survivors followed-up at a regional center in the North of England were risk-stratified by disease and treatments received into one of three levels. These data were linked with local cancer registry and administrative health data (Hospital Episode Statistics), where hospital activity was used as a marker of late morbidity burden. Results Poisson modelling with incident rate ratios (IRR) demonstrated similar trends in hospital activity for childhood (CH) and YA cancer survivors across NCSI risk levels. NCSI levels independently predicted long-term hospitalization risk in both CH and YA survivors. Risk of hospitalization was significantly reduced for levels 1 (CH IRR 0.32 (95% CI 0.26–0.41), YA IRR 0.06 (95% CI 0.01–0.43)) and 2; CH IRR 0.46 (95% CI 0.42-0.50), YA IRR 0.49 (95% CI 0.37-0.50)), compared with level 3. Conclusions The NCSI pediatric late-effects risk stratification system can be effectively and safely applied to cancer patients aged 18–29, independent of ethnicity or socioeconomic position. Implications for Cancer Survivors To enhance quality of care and resource utilization, long-term aftercare of survivors of YA cancer can and should be risk stratified through adoption of approaches such as the NCSI risk-stratification model. Electronic supplementary material The online version of this article (10.1007/s11764-020-00939-y) contains supplementary material, which is available to authorized users.
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McCann L, McMillan KA, Pugh G. Digital Interventions to Support Adolescents and Young Adults With Cancer: Systematic Review. JMIR Cancer 2019; 5:e12071. [PMID: 31368438 PMCID: PMC6693302 DOI: 10.2196/12071] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/16/2019] [Accepted: 06/28/2019] [Indexed: 01/30/2023] Open
Abstract
Background The last decade has seen an increase in the number of digital health interventions designed to support adolescents and young adults (AYAs) with cancer. Objective The objective of this review was to identify, characterize, and fully assess the quality, feasibility, and efficacy of existing digital health interventions developed specifically for AYAs, aged between 13 and 39 years, living with or beyond a cancer diagnosis. Methods Searches were performed in PubMed, EMBASE, and Web of Science to identify digital health interventions designed specifically for AYA living with or beyond a cancer diagnosis. Data on the characteristics and outcomes of each intervention were synthesized. Results A total of 4731 intervention studies were identified through the searches; 38 interventions (43 research papers) met the inclusion criteria. Most (20/38, 53%) were website-based interventions. Most studies focused on symptom management and medication adherence (15, 39%), behavior change (15, 39%), self-care (8, 21%), and emotional health (7, 18%). Most digital health interventions included multiple automated and communicative functions such as enriched information environments, automated follow-up messages, and access to peer support. Where reported (20, 53% of studies), AYAs’ subjective experience of using the digital platform was typically positive. The overall quality of the studies was found to be good (mean Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields scores >68%). Some studies reported feasibility outcomes (uptake, acceptability, and attrition) but were not sufficiently powered to comment on intervention effects. Conclusions Numerous digital interventions have been developed and designed to support young people living with and beyond a diagnosis of cancer. However, many of these interventions have yet to be deployed, implemented, and evaluated at scale.
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Affiliation(s)
- Lisa McCann
- Digital Health and Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Kathryn Anne McMillan
- Digital Health and Wellness Group, Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Gemma Pugh
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
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Pugh G, Hough R, Gravestock H, Davies C, Horder R, Fisher A. The development and user evaluation of health behaviour change resources for teenage and young adult Cancer survivors. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:9. [PMID: 30815279 PMCID: PMC6377718 DOI: 10.1186/s40900-019-0142-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
PLAIN ENGLISH SUMMARY This paper describes the methods that were used to develop a health behaviour intervention specifically for teenage and young adult cancer survivors (TYACS). The program of work, carried out in partnership with CLIC Sargent (a UK based cancer charity for children and young people) was guided by The Behaviour Change Intervention Design Process. A systematic review of existing intervention studies was carried out and TYACS were surveyed on their interest in receiving health behaviour information and their preference regarding the format, delivery and timing of such information. Health professionals were also surveyed to gather their views on how health behaviour information would be best delivered to young people with cancer. The results of these studies informed the development of a collection of health behaviour change intervention resources containing comprehensive lifestyle information and behaviour change support tools. TYACS and TYA health professionals were invited to review and provide feedback on the relevance, appeal and usability of the resources. It is hoped that by involving TYACS and TYA representatives at every stage of intervention development the problem of low uptake and adherence commonly encountered during intervention piloting will be prevented. ABSTRACT Background Teenage and Young Adult Cancer Survivors (TYACS) are advised to adopt a healthy lifestyle in order to reduce the impact of cancer and its treatments upon their long-term health. However, at present there are no interventions available in the UK to support TYACS to lead a healthy lifestyle. To inform the development of a lifestyle intervention for TYACS a partnership was set up between academic behavioural scientists and CLIC Sargent, a cancer charity which supports children and young people. Methods A series of studies to understand patient and professionals needs and perspectives regarding health behaviour change were carried out. TYACS were surveyed to gather data on their current health behaviour status; interest in, and experience of receiving, lifestyle advice; and preference regarding the type, format, and delivery of a lifestyle intervention. Health care professionals were surveyed simultaneously to gather their views on how best to promote health behaviour change to TYACS. In this paper we summarise key findings from the development work, the resulting lifestyle intervention, and new data from a preliminary evaluation study exploring TYACS and TYA health professionals' views on the relevance, appeal and usability of the intervention resources. Results A collection of health behaviour change intervention resources containing lifestyle information and behaviour change support tools were developed. These intervention resources were well received by TYACS and health professionals with the majority rating the information as high quality, helpful and relevant. Over 80% of TYACS reported they would find the support tools 'very appealing' or 'quite appealing'. TYACS and health professionals provided feedback on how the resources could be improved including commenting that more personalized or tailored health behaviour information would be beneficial. Discussion and conclusion It is hoped that by involving TYACS and TYA representatives at every stage of intervention development,and carrying out a preliminary evaluation of the intervention resources, the problem of low uptake and adherence commonly encountered during formal intervention piloting and evaluation will be prevented.
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Affiliation(s)
- Gemma Pugh
- Department of Behavioural Science & Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
- Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK
| | - R. Hough
- Department of Haematology, University College London Hospital, London, UK
| | - H. Gravestock
- CLIC Sargent, No. 1 Farriers Yard, Assembly London, 77-85 Fulham Palace Road, London, UK
| | - C. Davies
- CLIC Sargent, No. 1 Farriers Yard, Assembly London, 77-85 Fulham Palace Road, London, UK
| | - R. Horder
- CLIC Sargent, No. 1 Farriers Yard, Assembly London, 77-85 Fulham Palace Road, London, UK
| | - A. Fisher
- Department of Behavioural Science & Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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Oh SM, Park SY, Lee HJ, Lee JH. Measurement Properties of Self-Report Questionnaires Measuring the Social Adjustment for Youth after Treatment of Childhood Cancer: Systematic Review. CHILD HEALTH NURSING RESEARCH 2018. [DOI: 10.4094/chnr.2018.24.1.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Kobayashi K, Nakagami-Yamaguchi E, Hayakawa A, Adachi S, Hara J, Tokimasa S, Ohta H, Hashii Y, Rikiishi T, Sawada M, Kuriyama K, Kohdera U, Kamibeppu K, Kawasaki H, Oda M, Hori H. Health-related quality of life in Japanese children with acute lymphoblastic leukemia during and after chemotherapy. Pediatr Int 2017; 59:145-153. [PMID: 27422759 DOI: 10.1111/ped.13092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality of life (QOL) as a treatment outcome has not yet been evaluated among patients receiving a specific treatment regimen by treatment phase in a consistent manner. This exploratory cross-sectional study evaluated the QOL of children with acute lymphoblastic leukemia (ALL) receiving one of the most popular treatment regimens in Japan (Japan Association of Childhood Leukemia Study ALL-02 revised protocol). METHODS Children aged 5-18 years with newly diagnosed B-cell precursor ALL were included. The Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL-J) were completed by children with ALL and their siblings, as well as by age- and sex-matched healthy controls. PedsQL Cancer Module (PedsQL-C) scores were also collected from children with ALL. RESULTS QOL in children with ALL of the consolidation phase group was significantly decreased compared with that of healthy controls, except in the area of emotional functioning. Regarding the maintenance phase group, QOL impairment was noted in the physical and school functioning, but no differences were noted in social functioning. The off-treatment group had a large effect size only for physical functioning, and the social functioning score was even better in children with ALL than in matched controls. QOL of children with ALL differed with treatment phase. Effect size varied with function and treatment phase. CONCLUSIONS QOL may change with the progression of treatment, and the timing of these changes varied according to function and problem.
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Affiliation(s)
- Kyoko Kobayashi
- Department of Child Health Nursing, St Luke's International University Graduate School of Nursing Science, Chuo, Japan
| | - Etsuko Nakagami-Yamaguchi
- Department of Medical Quality and Safety Science, Osaka City University Graduate School of Medicine, Abeno, Japan
| | - Akira Hayakawa
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Souichi Adachi
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, Japan
| | - Junichi Hara
- Department of Pediatric Hematology Oncology, Children's Medical Cancer Osaka City General Hospital, Toshima, Japan
| | - Sadao Tokimasa
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Abeno, Japan
| | - Hideaki Ohta
- Department of Pediatrics, Higashitoyonaka Watanabe Hospital, Toyonaka City, Japan
| | - Yoshiko Hashii
- Department of Developmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Rikiishi
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Machiko Sawada
- Department of Pediatrics, Takashima Municipal Hospital, Takashima, Shiga, Japan
| | - Kikuko Kuriyama
- Aichi Children's Health and Medical Cancer, Obu, Aichi, Japan
| | | | - Kiyoko Kamibeppu
- Department of Family Nursing, Graduate School of Medicine, University of Tokyo, Bunkyo, Tokyo, Japan
| | - Hirohide Kawasaki
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Megumi Oda
- Graduate School of Health Sciences, Okayama University, Kita, Okayama, Japan
| | - Hiroki Hori
- Mie University Graduate School of Medicine, Tsu, Mie, Japan
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