Adolescents and young adults with oncohematological disease: use of social networks, impact of SARS-COV-2, and psychosocial well-being

Objective

Adolescents and young adults (AYA) with oncohematological diseases could have important psychosocial difficulties that could be worsened by the effects of the COVID19 pandemic. At this developmental stage, it is also important to assess the use of social networks (SNs). This study aims to investigate the type of social network use and the consequences of the COVID19 period. These patients are compared with matched healthy peers.

Methods

After the informant consent signature, the adolescents completed a series of self-report questionnaires on the use of SNs, on communication preferences, on social anxiety and on Covid19 impact through the online platform of LimeSurvey. Most of the adolescents belonged to the 18-20 age group (42.5%), were female (62%) and mainly off therapy (72%).

Results

Adolescents spent more than 2 h/day on Instagram and 1 h and half on Whatsapp, while Tik Tok use was on average 1 h/day, especially used by younger patients (r = -0.33, p = 0.023). Males used Twitch (t45 = -2.06, p = 0.05) and Youtube (t45 = -2.18, p = 0.03) for longer than females. AYA in therapy used more Tik Tok (U = 137.50; p = 0.03), Ask/Tellonym (U = 172.50; p = 0.05) and Twitch (U = 144; p = 0.017) than those off therapy. Healthy AYA showed lower levels of exposure (Z = -4.17; p = 0.00001) and impact (Z = -5.12; p = 0.00001) to Covid19, while the level of social anxiety is comparable and is in the normal range in both groups.

Discussion

Some clinical considerations and suggestions could be given based on these empirical results to health professionals in the care of AYA cancer patients.

Increasing Vaccine Uptake during Pregnancy by Using Prenatal Education Classes: An Effective Tool for Health Communication and Promotion

Childbirth education classes represent an antenatal tool for supporting pregnant women and couples in increasing knowledge on pregnancy, delivery, breastfeeding, and newborn care. The aim of this study was to investigate the impact of an additional lesson during the prenatal course regarding the advantage of vaccination to mitigation of maternal anxiety. An observational study was designed that included participants in childbirth education classes and compared courses enhanced by the extra lesson on vaccination during pregnancy versus those who did not receive it. Assessment of the impact of prenatal educational on vaccination was measured by using validated questionnaires (State-Trait Anxiety Inventory, STAI; Perceived Stress Scale, PSS; World Health Organization- Five Well-Being Index, WHO-5). A total of 145 pregnant women participated to the investigation by answering to the online survey. Of them, 33 patients (22.8%) belonged to the course without a lesson on vaccine, while 112 (77.2%) participated to online prenatal education that included an additional meeting on the usefulness of getting vaccinated during pregnancy. No statistical differences were found between study groups in terms of demographics and perinatal outcomes. Participants in the enriched course reported lower basal anxiety levels than those without the vaccine lesson (STAI-State, normal score < 40, 30 vs. 19%, p-value 0.041; STAI-State, mild score 40-50, 78 vs. 67%, p-value 0.037). With reference to the prior two weeks, maternal wellbeing level was improved by the added class (score > 13 as measurement of wellbeing: 62% vs. 80%, p-value < 0.05). Moderate perceived stress assessed by PSS was found in those pregnant women without prenatal education on vaccination (64 vs. 50%, p-value 0.042). The introduction of a lesson regarding vaccination during pregnancy in the program of prenatal education courses improved maternal anxiety levels and wellbeing, in addition to reducing perceived stress.

"One and a Half Years of Things We Could Have Done": Multi-Method Analysis of the Narratives of Adolescents with Type 1 Diabetes during the COVID-19 Pandemic

BACKGROUND

Public health interventions for COVID-19 forced families to adopt changes in daily routines that affected children's and adolescents' psychological well-being. In youth with type 1 diabetes (T1D), psychological symptoms may compromise glycemic control and outcomes; however, evidence of improved glycemic control in children and adolescents with T1D emerged early during the pandemic. This qualitative study aims to provide a more in-depth understanding of how the COVID-19 pandemic affected adolescents' with T1D routines, experiences, T1D management, and psychological well-being.

METHODS

24 adolescents, aged 15-18 years, with T1D, joined focus-group discussions during the diabetes summer camp. Word frequency analysis and thematic analysis were conducted on adolescents' narratives. The average frequencies of use of words related to COVID-19 and to T1D were compared by t-test.

RESULTS

Word frequency analysis identified "friends", "family", and "home" as the most recurrent terms. Seven themes were highlighted: (1) COVID-19 and T1D; (2) emotional reactions to the COVID-19 pandemic; (3) changes in daily life; (4) feelings of loss; (5) coping with the COVID-19 pandemic; (6) the COVID-19 pandemic as opportunity; (7) return to (new) normality. COVID-19 related words were on average more frequent than words referring to T1D.

CONCLUSIONS

The COVID-19 pandemic may have represented a more stressful condition for adolescents with T1D, facing additional challenges compared to their healthy peers. Findings offer directions to the diabetes care team for customized interventions while the effects of the pandemic on adolescents' health continue.

Impact of the COVID-19 Pandemic on Psychosocial Well-being and Adaptation in Children and Adolescents with Asperger's Syndrome

Mental health could worsen in children and adolescents with autism spectrum disorder during the COVID-19 pandemic. In addition, their parents could be more at risk for an increase in anxiety and depression symptomatology. This study aims to understand the adaptation and the psychosocial well-being in a sample of 16 males aged 10-21 years old with Asperger's syndrome after the quarantine for COVID-19 when they return to school and partially to their activities in September 2020. The adopted approach is multi-informant with a battery of questionnaires on psychological health and adaptation given by a secure online web data Qualtrics both to adolescents and also to their parents. Paralleling matched peers with typical developments were assessed by adopting the same methodology. The results evidenced several difficulties in psychological health in population with Asperger's syndrome, especially in anxiety and socialization. Adaptation is put in crisis, even if they reported a good comprehension and adoption of the right behaviors anti-COVID-19. Parents of children with Asperger's syndrome reported similar psychological difficulties and general health to those of the group of children typically developing. Some clinical indications could be discussed for psychologists who follow children and adolescents with Asperger's syndrome.

Tactile Biography Questionnaire: A contribution to its validation in an Italian sample

As the interest in the beneficial effects of positive touch experiences is rapidly growing, having reliable and valid tools to its assessment is essential. The Tactile Biography Questionnaire (TBQ) allows to quantify individual differences in affective touch experiences throughout life. The aim of this article is to present a contribution to its validation in the Italian population. Data analysis were run on a sample of 2040 Italian individuals (Females = 1342, 64%) participating in an on-line survey. Confirmatory Factor Analysis and invariance analyses for gender were applied. Concurrent validity was checked using two specific subscales of the Touch Avoidance Questionnaire (TAQ—i.e., Family and Stranger). The four-dimensional structure of the TBQ was confirmed in the overall sample and by gender. Also, the TBQ showed an excellent internal consistency and a good concurrent validity with TAQ. The present study suggests that the TBQ can be used to support healthcare professionals and researchers to assess experiences of affective touch in different settings.

Psychological Well-Being, Cognitive Functioning, and Quality of Life in 205 Adolescent and Young Adult Childhood Cancer Survivors Compared to Healthy Peers

The majority of the studies underlined how adolescent and young adult (AYA) Cancer Survivors had no significant differences in their well-being and quality of life compared with a control group of healthy counterparts, although French et al. (2013) found less years of education among cancer survivors. The present study aimed at comparing AYA cancer survivors and a control group of peers who had no history of serious illness, in terms of well-being, cognitive functioning, and perceptions of life. Participants in this study were 205 AYA cancer survivors, 126 males, off therapy from a mean of 10.87 years (SD = 4.91), with a mean age of 18.96 (SD = 3.08), recruited during follow-up visits and healthy counterparts (n = 205), matched for age and gender. They all completed self-report questionnaires: Ladder of Life, BSI-18 and Cognitive problems. Paired t test evidenced significant differences between survivors (Mean = 6.19; SD = 2.07) and controls (Mean = 6.88; SD = 2.02) in perceptions of quality of life regarding 5 years before the current time [t₍₂₀₄₎ = −3.39; p = 0.001], with a lower level for childhood cancer survivors. Specifically, Hierarchical regression (R² = 0.05, p = 0.04) identified a shorter time since the completion of treatment (β = 0.18, p = 0.03) and a trend of stem cell transplantation experience (β = −0.11, p = 0.06) as factors associated with negative perception of precedent quality of life. The AYA cancer survivors reported lower cognitive difficulties (Mean = 1.46) than controls (Mean = 1.56) [t₍₂₀₄₎ = −3.41; p = 0.001]: in memory (Mean_clinical = 1.32 vs Mean_control = 1.50) [t₍₂₀₄₎ = −4.52; p = 0.001], in concentration (Mean_clinical = 1.36 vs Mean_control = 1.54) [t₍₂₀₄₎ = −4.66; p = 0.001] and in mental organization skills (Mean_clinical = 1.47 vs Mean_control = 1.56) [t₍₂₀₄₎ = −2.56; p = 0.01], even if they had a lower educational attainment [X(9)2 = 131.28; p = 0.001]. They showed similar satisfaction with their psychological well-being and their lives as healthy counterparts, except for past life perceptions associated with the cancer period. Important recommendations for future research and clinical suggestions could be given.

QOL-33. Adaptive behaviour of patients treated for malignant brain tumor in the first three years of life

BACKGROUND: Adaptive behavior is defined as the effectiveness and degree to which an individual meets social/cultural standards of personal independence and social responsibility. Patients treated for brain tumor are at risk of alteration of adaptive behaviour that, with a reduced intellectual function, makes diagnosis of mental retard. OBJECTIVE: The aim of this study was to evaluate the adaptive behaviour of patients treated for malignant brain tumor in the first three years of life and the variables that may correlate with its alteration. PATIENTS AND METHODS: Twelve survivors of brain tumor diagnosed in the first three years of life followed in the Pediatric Hematology and Oncology Department of Padua between January 2000 and December 2020 were enrolled in this study. We defined the level of the adaptive behaviour by evaluation adaptive behavior questionnaire (ABAS II) completed by the parents. RESULTS: None of the patients shows a high level of adaptive behavior. Preliminary evidences suggest that, the level of adaptive behavior may be influenced by the sex, irradiation and time from the end of treatment. In details, females show a higher level of performance than males, patients not treated with radiotherapy performed better than patients irradiated and longer-term survivors have a better level of adaptive behaviour. CONCLUSIONS: This study confirms that patients treated for brain tumor show a lower level of adaptive behaviour than peers. The future objective is to assess adaptive behaviour at many times to recognize the problem early.

Pain coping strategies in paediatric patients newly diagnosed with leukaemia compared with healthy peers

Objective

Children with leukaemia experience special difficulties adapting to stressful medical procedures and to the adverse effects of chemotherapy, though they can implement their coping strategies.

The aims of the study were to assess whether the coping‐with‐pain strategies could be influenced by a child's personal and illness factors and to render possible comparisons between children with leukaemia and healthy peers. Another aim was to compare parents' and children's reports on coping strategies.

Methods

A total of 125 patients (average age = 6.79 years; SD = 3.40) with acute leukaemia (lymphocytic leukaemia 90.4% and myeloid leukaemia 9.6%) and age‐matched healthy children with their parents were enrolled in the study. A socio‐demographic questionnaire and the Waldon–Varni Pediatric Pain Coping Inventory, parent and self‐report versions, were administered 1 month after diagnosis. Data regarding the therapy's side effects were recorded.

Results

The comparison between proxy‐reports of the two groups of parents found significant differences in terms of social support, self‐cognitive instructions and catastrophising strategies. Children aged 6–10 years relied more heavily on distraction than children of other ages, using more problem‐solving and self‐cognitive instructions. The results indicated moderate parent–child agreement.

Conclusion

Health professionals could help paediatric leukaemic patients in adopting more efficiently pain coping strategies applicable for different ages.

Pain Coping Strategies in Pediatric Patients with Acute Leukemias in the First Month of Therapy: Effects of Treatments and Implications on Procedural Analgesia

Simple Summary

Children with leukemia have to adapt to several pain episodes related to medical procedures and to the treatment effects. This is one of the first multi-disciplinary studies involving different perspectives of pediatric hematologists, anesthetists, and psychologists. The aim of this study is to understand how specific coping strategies could be associated with the treatments’ factors and with the dosage of sedation analgesic drugs during bone marrow aspirates. Results underlined that patients’ coping with pain, such as distraction, could be influenced by treatment factors and by their age. The use of particular pain coping strategies (especially the request for social support) was associated with a lower demand for hypnotic sedative drugs during sedation for bone marrow aspirate. Contrarily, the catastrophic attitude was recognized as a negative factor that influenced a major dosage of propofol for the bone morrow sedations. Health professionals should strengthen these useful coping strategies and dampen the catastrophizing one.

Abstract

Children with leukemia experience difficulties adapting to medical procedures and to the chemotherapy’s adverse effects. Study’s objectives were to identify which coping strategies could be associated with the treatments’ factors and with the dosage of sedation analgesic drugs during bone marrow aspirates. A total of 125 patients (mean = 6.79 years; standard deviation = 3.40), majority with acute lymphoblastic leukemia (90.4%) and their parents received, one month after diagnosis, the Pediatric Pain Coping Inventory. Data on the severe treatment effects and on the dosage of drugs in sedation-analgesia were also collected. An ANCOVA model (R² = 0.25) showed that, weighing the age factor (F = 3.47; df = 3; p = 0.02), the number of episodes of fever (F = 4.78; df = 1; p = 0.03), nausea (F = 4.71; df = 1; p = 0.03) and mucositis (F = 5.81; df = 1; p = 0.02) influenced the use of distraction. Cognitive self-instructions (R² = 0.22) were influenced by the number of hospitalizations (F = 5.14; df = 1; p = 0.03) and mucositis (F = 8.48; df = 3; p = 0.004) and by child’s age (F = 3.76; df = 3; p = 0.01). Children who sought parental support more frequently (F = 9.7; df = 2; p = 0.0001) and who tended not to succumb to a catastrophic attitude (F = 13.33; df = 2; p = 0.001) during the induction treatment phase required lower drug dosages, especially propofol. The clinical application of these results could be to encourage the use of cognitive self-instructions and search for social support.

Health-Related Quality of Life, Family Conflicts and Fear of Injecting: Perception Differences between Preadolescents and Adolescents with Type 1 Diabetes and Their Mothers

Good management of diabetes requires at the same time self-regulation behaviour and a balanced involvement of family components. This cross-sectional study’s aims were: understanding fear of injections and perceptions of family conflicts in preadolescents and adolescents with type 1 diabetes mellitus and their mothers, comparing their perceptions, and identifying the risk factors impacting patients’ quality of life. Eligibility criteria were: treatment for diabetes mellitus type I, currently aged 10–18 years, attending the hospital for annual hospital follow-ups. Exclusion criteria were: intellectual disabilities, inability to complete questionnaires alone and neuropsychiatric illness with active pharmacotherapy. The study design was cross-sectional. Participants were one hundred and two patients (Mean age = 14.6, SD = 2.4; age range = 10–19 years; Females = 52 and Males = 50) and their mothers (Mean age = 46.9, SD = 6.2, age range = 27–63 years), who filled in self and proxy-report questionnaires (N total= 204). The results showed that 20% of patients and 14.7% of their mothers reported clinical scores for fear of self-injection and blood testing. The mothers reported lower fear of injecting and higher family conflicts compared with the patients. Age, fear of injecting and family conflicts were significantly associated with patients’ quality of life perceptions. Clinical considerations and recommendations are given based on the empirical results.

Quality of Life and Symptoms of PTSD during the COVID-19 Lockdown in Italy

The COVID-19 pandemic has led to a complete lockdown in many countries and Italy was the first country interested in Europe, as the cases spread very quickly with a high rate of mortality. While the lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, it can have a significative impact on mental health on the population involved, that is still not well known and must be explored. The objective of the present research is to investigate the Quality of Life (QoL) and Symptoms of PTSD (PTSS) encountered during the quarantine period (April 2020) due to the spread of COVID-19 in Italy. Participants (N = 1839; 1430 females and 409 males), who were volunteers and anonymous, adults (18-73 years), were drawn from a convenience sample of the general population and asked to fill out an online questionnaire, after giving an informed written consent. The General Health Questionnaire (GH12), used to assess health related QoL, identified 24.5% of respondents as problematic, and the Impact of Event Scale-Revised (IES-R), used to assess PTSS, identified the 23.5% with clinical scores. Results showed that married people/cohabitants, non-workers, and those with a lower level of education perceived a better QoL and less PTSS. The most frequent emotions felt during the first month of quarantine and referred to by participants were sadness (72%), boredom (54.5%), impotence (52%), and anxiety (50%). The COVID-19 pandemic represents one of the most stressful events in recent times worldwide and poses a major challenge for social, economic, and, above all, psychological resources of the population that must be assessed and supported if insufficient.

A mixed-methods study of the disease experience in hematopoietic stem cell transplantation survivors: the contribution of text analysis

OBJECTIVES

Few studies have detected qualitative and quantitative aspects of patients who underwent HSCT during childhood. The aims of this study are to explore the most recurrent narrative themes of HSCT experience in families five years after the procedure, and to observe statistical correlations between meaning attributed to the experience and defined variables.

METHODS

Thirty-five families of pediatric HSCT survivors participated in the research. Both survivors and their families were asked to write a brief composition about their disease experiences. Qualitative analysis of the texts was performed using the T-LAB software. Information about medical aspects and psychological problems in HSCT survivors were collected with interviews and administering the Child Behavior Checklist 6-18.

RESULTS

HSCT survivor families that reported the presence of externalizing and internalizing symptoms focused on thematic areas concerning broken families with separation between parents and the affected child versus healthy children.

CONCLUSIONS

Long term psychological problems seem to be connected to the perception of family disruption. Specifically, family relationships seem to be the factor that protects from or enhances the risk of psychopathology in HSCT survivors. Moreover, the use of metaphoric terms to refer to HSCT presents higher associations with psychopathology. On the contrary, the possibility of referring directly to the transplantation is associated with psychological well-being. It is important to consider the family as a group in order to improve care.

Pediatric Patients Treated for Leukemia Back to School: A Mixed-Method Analysis of Narratives about Daily Life and Illness Experience

In the last few years, more children and adolescents healed from leukemia go back to their daily life, even if they can show some psycho-social difficulties. The study adopted semi-structured interviews and a mixed-method approach to examine the narratives of 75 children and adolescents about their return to school post 2-years treatment for leukemia. The aims are to collect their illness experiences, to understand how they feel about school and daily routines and to identify the best socio-demographic and illness predictors of a good re-adaptation to school and daily life. The results show that by increasing age and when the pediatric patient have received a hematopoietic stem cell transplantation, at the stop-therapy time, her/his perception about relationships at school and academic performance decrease, especially if his/her feelings about the disease and follow-up visits are negative.

Health Locus of Control in Parents of Children with Leukemia and Associations with Their Life Perceptions and Depression Symptomatology

In childhood cancer, parents have an important role in the promotion of their children's wellbeing and in their adoption of a locus of control style towards their children's health. The current study aimed at identifying types of locus of control in parents of children with leukemia and the possible association with depressive symptomatology and current life perception. One hundred and four parents were recruited at the Hematology-Oncology Clinic of the Department of Woman's and Child's Health, University of Padua, one month after a leukemia diagnosis. Participants were Caucasian with a mean age of 37.28 years (SD = 5.89), mostly mothers (87.5%) and with a mean of 12.16 years of education (SD = 3.82). After signing the informed consent, they filled in the Ladder of Life, the Brief Symptom Inventory-18 and the Parental Health Locus of Control (PHLOC) questionnaires. Paired-samples t-test (t = -14.42; df = 103; p = 0.0001) showed that parents of children with leukemia were more inclined to have an external locus of control than an internal one. The hierarchical regression analysis model (R² = 0.34; F = 4.32; p = 0.0001) identified health professional influence (ß = -0.28; p = 0.004), current life perception (ß = -0.3; p = 0.013) and future life perception (ß = -0.26; p = 0.012) as significant predictors of parental depression. Current life perception was best predicted (R² = 0.25; F = 3.96; p = 0.01) by the parental influence locus of control style (ß = 0.25; p = 0.03). Improving trust in the medical staff care and strengthening the internal locus of control in parents could be a preventive program to cope with parental depression symptomatology.

Impact of Psycho-Educational Activities on Visual-Motor Integration, Fine Motor Skills and Name Writing among First Graders: A Kinematic Pilot Study

This pilot study presents the effects on acquisition of pre-writing skills of educational activities targeting visual-motor integration and fine motor skills on a convenient sample of first graders. After a 10-week intervention program, visual perceptual skills and fine motor control were tested on 13 six-year-old aged children. Participants completed the Beery-Buktenica VMI and the manual dexterity scale of the Movement ABC-2 at baseline (T1), after the intervention program (T2), and one month after the end of the educational activities (T3). Children's writing pressure, frequency, and automaticity were measured using a digitizer during the administration of name writing test at T1, T2, and T3. The purpose of the study was to investigate changes in visual-perceptual abilities and fine motor skills after the intervention program and examine correlational effects on children's kinematic writing performances. Findings reveal that educational activities impacted positively on children's visual motor coordination component of writing improving VMI scores. No statistically significant difference was detected across the three time points on students' manual dexterity skills. Measurement of writing kinematics allows to report and document variations in children's writing during intervention. This pilot study discusses these findings and their implications for the field on early childhood acquisition of foundational skills for handwriting. It also proposes potential topics for future research on this field.

Who Benefits from An Intervention Program on Foundational Skills for Handwriting Addressed to Kindergarten Children and First Graders?

This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement Assessment Battery for Children-2 (MABC-2): before the intervention (T1), post-intervention (T2) and one month later (T3). Research findings: Significant improvements were found on VMI between T1 and T2, particularly for kindergartners. Neither group of children demonstrated changes on manual dexterity scores. The present study showed that the intervention program led to different changes in the at-risk of motor impairment group than in the not at-risk children. Results indicated that games and stimulation activities helped children below the 16th percentile over time in the manual dexterity domain. A gender effect was observed, with female children increasing their abilities over time more than male peers. Future research should concentrate on stimulating fine motor skills in hand manipulation and test how these abilities influence graphomotor skills and handwriting over time. Finally, more research is needed to determine the impact of activities and games carried out in educational settings.

Psychological Wellbeing in Adolescents with Leukaemia: A Comparative Study with Typical Development Peers

There is still little research on psychological wellbeing, life satisfaction and reported problems in preadolescents and adolescents under therapy for leukaemia, and also little research comparing them with their healthy peers. The present study aimed to analyse the life satisfaction, hope, psychological wellbeing and reported problems’ intensity in 60 patients aged 8–18 during the first year of therapy, to identify those more at risk and to compare their reports with matched healthy peers. A battery of self-reported questionnaires was administered during hospitalisation or day hospital admissions post 6 months and post 12 months from the diagnosis. Younger patients (aged 8–13 years) were more at risk than older ones in their problems’ intensity and psychological symptoms; females and Acute Myeloid Leukaemia patients reported lower current life satisfaction perceptions; hope was associated with lower depression symptoms and mood problems. Healthy peers have a better perception of current life, but reported a lower hope score, more anxiety symptoms and more cognitive problems than patients. The first 6 months were more critical for patients’ psychological health. Basing on these empirical data, the inclusion of mental health care professionals or supportive psychotherapy into the treatment is recognized as extremely useful.

Adolescent and young adult cancer survivors narrate their stories: Predictive model of their personal growth and their follow-up acceptance

PURPOSE

Few studies have captured the unique ways in which cancer affects the growth and development of adolescent and young adult cancer survivors. This paper illustrates the daily life of childhood cancer survivors who are now adolescents and young adults, their post-traumatic growth and follow-up perceptions, adopting a narrative approach.

METHODS

One thousand adolescent and young adult cancer survivors, mean age at diagnosis being 9.26 years old (SD = 4.29) and current mean age of 19.28 (SD = 2.96), were interviewed in depth using a new version of Ecocultural Family Interview-Cancer (EFI-C), which has proved to be a psychometrically reliable instrument.

RESULTS

Post-traumatic growth was predicted directly by age at diagnosis and, indirectly, by the mediation of the health medical staff-patient relationship during the illness, hospitalization memories, and patient's narrating skills. Positive feelings towards follow-up visits were predicted by the health staff-patient relationship during the illness (Chi-Square = 2.87; df = 3, p-value = 0.41; RMSEA = 0.0001).

CONCLUSION

Adolescent and young adult cancer survivors who were older and had established strong relationships with health professionals at the clinic were more able to narrate their experiences, display a positive comprehension of the events with a pragmatic acceptance of the follow-up procedures. Relationships with health professionals should therefore be monitored and improved, both during the cancer treatment and in the off-therapy period. The narrative technique allows adolescent and young adult cancer survivors to reorganize and give shape to their traumatic experience.

Quality of Life and Psychopathology in Adults Who Underwent Hematopoietic Stem Cell Transplantation (HSCT) in Childhood: A Qualitative and Quantitative Analysis

Background: Patients who undergo pediatric Hematopoietic Stem Cell Transplantation (HSCT) may experience long-term psychological sequelae and poor Quality of Life (QoL) in adulthood. This study aimed to investigate subjective illness experience, QoL, and psychopathology in young adults who have survived pediatric HSCT.

Method: The study involved patients treated with HSCT in the Hematology-Oncology Department between 1984 and 2007. Psychopathology and QoL were investigated using the SCL-90-R and SF-36. Socio-demographic and medical information was also collected. Finally, participants were asked to write a brief composition about their experiences of illness and care. Qualitative analysis of the texts was performed using T-LAB, an instrument for text analysis that allows the user to highlight the occurrences and co-occurrences of lemma. Quantitative analyses were performed using non-parametric tests (Spearman correlations, Kruskal-Wallis and Mann-Whitney tests).

Results: Twenty-one patients (9 males) participated in the study. No significant distress was found on the SCL-90 Global Severity Index, but it was found on specific scales. On the SF-36, lower scores were reported on scales referring to bodily pain, general health, and physical and social functioning. All the measures were significantly (p < 0.05) associated with specific socio-demographic and medical variables (gender, type of pathology, type of HSCT, time elapsed between communication of the need to transplant and effective transplantation, and days of hospitalization). With regard to the narrative analyses, males focused on expressions related to the body and medical therapies, while females focused on people they met during treatment, family members, and donors. Low general health and treatment with autologous HSCT were associated with memories about chemotherapy, radiotherapy, and the body parts involved, while high general health was associated with expressions focused on gratitude (V-Test ± 1.96).

Conclusion: Pediatric HSCT survivors are more likely to experience psychological distress and low QoL in adulthood compared with the general population. These aspects, along with survivors' subjective illness experience, show differences according to specific medical and socio-demographic variables. Studies are needed in order to improve the care and long-term follow-up of these families.

Self-Esteem and Academic Difficulties in Preadolescents and Adolescents Healed from Paediatric Leukaemia

Adolescents with cancer may demonstrate problems in their self-esteem and schooling. This study aims to screen the preadolescents and adolescents more at risk in their self-esteem perception and schooling difficulties post-five years from the end of therapy. Twenty-five paediatric ex-patients healed from leukaemia were recruited at the Haematology-Oncologic Clinic (University of Padua). The mean age of the children was 13.64 years (Standard Deviation (SD)) = 3.08, range = 10-19 years), most were treated for acute lymphoblastic leukaemia (ALL) (84%) and relatively equally distributed by gender. They filled in the Multidimensional Self-Esteem Test, while parents completed a questionnaire on their child's schooling. Global self-esteem was mostly below the 50 percentile (58.5%), especially regarding interpersonal relationships (75%). An independent sample t-test showed significant mean differences on the emotionality scale (t = 2.23; degree of freedom (df) = 24; p = 0.03) and in the bodily experience scale (t = 3.02; df = 24; p = 0.006) with survivors of Acute Myeloid Leukaemia (AML) having lower scores. An Analysis of Variance (ANOVA) showed significant mean differences in the bodily experience scale (F = 12.31; df = 2, p = 0.0001) depending on the survivors' assigned risk band. The parent reports showed that 43.5% of children had difficulties at school. Childhood AML survivors with a high-risk treatment were more at risk in their self-esteem perceptions. Preventive interventions focusing on self-esteem and scholastic wellbeing are suggested in order to help their return to their normal schedules.

Psychopathological Aspects in Childhood Hematopoietic Stem Cell Transplantation (HSCT): The Perception of Parents and Adolescents

Background: Data about psychosocial sequelae of childhood Hematopoietic Stem Cell Transplantation (HSCT) are limited and the association with a specific donor type or other medical factors is largely unknown (Chang et al., 2012). The aim of the present study was to compare the psychological aspects of pediatric HSCT survivors with healthy peers. A secondary aim was to detect whether parents and children differed in the perception of mental health status. The influence of medical factors on psychological status was also examined. Method: Thirty seven HSCT survivors (23 males) with a mean age of 14.4 years (SD = 3.03; range 8.16-18.33) were recruited. Twenty-six patients underwent an allogenic HSCT (matched unrelated donor, n = 20; matched sibling donor, n = 6) and 11 patients received an autologous HSCT. The children psychological aspects were assessed using the Youth Self Report (YSR) (Achenbach and Rescorla, 2001) and compared to a group of matched healthy peers. At the same time, parents were requested to complete the Child Behavior Checklist 6-18 (Achenbach and Rescorla, 2001). Medical and socio-demographic data were also collected. Results: HSCT survivors reported significantly higher levels of somatic complains (t27 = 3.14; p = 0.004; mean = 3.1) when compared to healthy peers (mean = 1.5). The parent CBCL scores on "child total competence" exceeded the normative clinical cutoff in 48.6% cases. Inter-rater agreement between parent and patient reports was present only in three scales: total competence score (K = 0.06, p = 0.002), somatic complaints (K = 0.21, p = 0.003) and attention problems (k = 0.13; p = 0.02). According to Ancova models, internalizing problems were more frequent in HSCT from family donors (F2 = 3.13; p = 0.06) or in the presence of acute complications (F1 = 11.95; p = 0.003). Conclusion: In contrast to the perception of parents, pediatric HSCT survivors reported good psychological health. However, they complained about more somatic problems as compared with healthy peers. Medical aspects such as donor source and the presence of acute complications should be taken into consideration for the psychological approach in order to improve pediatric HSCT survivor care.

A Review of Demographic, Medical, and Treatment Variables Associated with Health-Related Quality of Life (HRQOL) in Survivors of Hematopoietic Stem Cell (HSCT) and Bone Marrow Transplantation (BMT) during Childhood

Hematopoietic stem cell transplantation (HSCT) is a standard treatment after disease relapse and failure of conventional treatments for cancer in childhood or as a first line treatment for some high-risk cancers. Since hematopoietic stem cells can be found in the marrow (previously called a bone marrow transplantation) or periphery, we refer to HSCT as inclusive of HSCT regardless of the origin of the stem cells. HSCT is associated with adverse side effects, prolonged hospitalization, and isolation. Previous studies have shown that survivors of HSCT are at particularly high risk for developing late effects and medical complications, and thus, in addition to survival, quality of life in survivors of HSCT is an important outcome. This review summarizes and distills findings on the health-related quality of life (HRQOL) of long-term childhood cancer survivors of HSCT and examines significant sociodemographic, medical, disease and treatment correlates of HRQOL, as well as the methodology of the studies (instruments, type of studies, timing of assessment, type of transplantation). Because previous reviews covered the studies published before 2006, this review searched three databases published between January, 2006, and August, 2016. The search identified nine studies, including 2 prospective cohort studies and 7 cross-sectional studies. All studies reported a follow-up time of >5 years. The review found that HRQOL is significantly impacted over time following childhood HSCT, with salient correlates of HRQOL found to be presence of a severe chronic health or major medical condition, graft vs. host disease (GVHD), or pain. Continual evaluation of HRQOL must be integrated into long-term follow-up after childhood HSCT, and intervention should be offered for those survivors with poor HRQOL. Longitudinal studies should be emphasized in future research to allow for predictor models of resilience and poor HRQOL.

Post-traumatic Stress Symptoms and Post-traumatic Growth in 223 Childhood Cancer Survivors: Predictive Risk Factors

With modern therapies and supportive care, survival rates of childhood cancer have increased considerably. However, there are long-term psychological sequelae of these treatments that may not manifest until pediatric survivors are into adulthood. The prevalence of post-traumatic stress disorder in young adult survivors of childhood cancer ranges from 6.2 to 22%; associated risk factors are young age at the assessment, female gender, low education level, and some disease-related factors. The aim of this study was to investigate, in adolescent and young adult (AYA) survivors of childhood cancer, the incidence and severity of post-traumatic stress symptoms (PTSSs), and to identify the risk factors and the associated post-traumatic growth (PTG) index. Participants were 223 AYA cancer survivors recruited during follow-up visits in the Oncohematology Clinic of the Department of Child and Woman’s Health, University of Padua. Data were collected from self-report questionnaires on PTSS incidence, PTG mean score, perceived social support, and medical and socio-demographic factors. Ex-patients’ mean age at the assessment was 19.33 years (SD = 3.01, 15–25), 123 males and 100 females, with a mean of years off-therapy of 9.64 (SD = 4.17). Most (52.5%) had survived an hematological disorder and 47.5% a solid tumor when they were aged, on average, 8.02 years (SD = 4.40). The main results indicated a moderate presence of clinical (≥9 symptoms: 9.4%) and sub-clinical PTSS (6–8 symptoms: 11.2%), with the avoidance criterion most often encountered. Re-experience symptoms and PTG mean score were significantly associated (r = 0.24; p = 0.0001). A hierarchical regression model (R² = 0.08; F = 1.46; p = 0.05) identified female gender (β = 0.16; p = 0.05) and less perceived social support (β = -0.43; p = 0.05) as risk factors to developing PTSS. Another hierarchical regression model assessed the possible predictors of the PTG total score (R² = 0.36; F = 9.1; p = 0.0001), with female gender (β = 0.13; p = 0.04), actual age (β = 0.52; p = 0.0001), younger age at the diagnosis (β = -0.3; p = 0.02), and less years off-therapy (β = -0.58; p = 0.0001) impacting on PTG.

Stress, burnout, and job satisfaction in 470 health professionals in 98 apheresis units in Italy: A SIdEM collaborative study

AIMS

In Italian and international background, there are no studies focusing on stress, burnout indicators, and job satisfaction in health professionals working in the apheresis units. This study aims to fill this void both for scientific and clinical reasons.

METHODS

The participants were 470 health professionals (220 physicians, 250 nurses), mostly female (73.4%), with an average age of 48.09 (with the 5° percentile under 32 years and the 95° percentile over 60), working in the Apheresis Units in the North (228), in the Center (131) and in the Southern-islands of Italy (111). The health professionals' years on the job were principally between one and 10 years (40.2%) or from 11 to 20 years (33.2%). The prevalent activity was therapeutic apheresis (48.5%). The self-report questionnaires were proposed electronically by a protected online site.

RESULTS

Important stress levels were identified in the health professionals. Physicians principally showed medium (47.5%) and high (35.8%) stress levels. Stress levels of nurses were mostly low (57.7%) or medium (25.7%). Female gender in nurses [t(268) = -3.29; P = 0.001] and in physician professions [t(217) = -3.01; P = 0.03] was a risk factor for stress. Both job categories were placed at a high risk level for burnout syndrome comparing with normative scales, especially the health professionals working in the center of Italy for the scales "Emotional exhaustion" [F(2) = 4.39; P = 0.013] and "Professional inefficacy" [F(2) = 4.38; P = 0.013].

CONCLUSIONS

Health professionals working in the apheresis unit show high stress levels and burnout risk. New preventive programs and specific clinical interventions should be constructed.

Post-traumatic stress symptoms among mothers of children with leukemia undergoing treatment: a longitudinal study

OBJECTIVE

To assess post-traumatic stress symptoms (PTSS) in mothers of children over 2 years of leukemia treatment, to identify possible early family and child predictors of this symptomatology and to indicate the temporal trajectory of PTSS.

METHODS

Participants were 76 Italian mothers (mean age = 37.30 years; SD = 6.07) of children receiving treatment for acute lymphoblastic (n = 69) or myeloid (n = 7) leukemia. Mothers had 12.05 years of education (SD = 3.87), and their incomes were average (52.1%), high (26%) and low (21.9%) for Italian norms, never in poverty. The pediatric patients with leukemia were equally distributed by gender with their mean age of 7.10 years (SD = 4.18). Post-traumatic stress symptoms were measured by a 17-item checklist. Scales assessing anxiety, depression, physical (Brief Symptom Inventory 18) and cognitive functioning (Problem Scale), and life evaluation were also used. There were five assessment points: 1 week (T1), 1 month (T2), 6 months (T3), 12 months (T4) and 24 months post-diagnosis (T5).

RESULTS

The main results indicated moderate presence of clinical PTSS (≥9 symptoms: 24% at T2, 18% at T3, 16% at T4 and 19% at T5) that remained stable across time points, whereas Brief Symptom Inventory 18 Global score decreased and life evaluation improved. A series of hierarchical regression models identified cognitive functioning early after the diagnosis as the best predictive factor of PTSS across time points.

CONCLUSION

Specific psychological interventions could be devised for mothers at risk for short and long-term PTSS just after the diagnosis.

Eliciting adaptive emotion in conversations with parents of children receiving therapy for leukemia

Clinician-parent communication may often be difficult, especially soon after the diagnosis. The aims of this article are to identify the communication strategies associated with expressions of adaptive emotions in parents and to explore the effect of the type of leukemia and of parent's gender on parents' expressions of emotions. The data are obtained from 4.622 conversational turns of 20 videotaped interviews with 10 mothers and 10 fathers of children at their first hospitalization for leukemia. A coding scheme for parent emotional expressions was reliably applied by two independent judges. An original self-report questionnaire on parents' emotional states was used before and after the interview. Positive politeness of interviewer elicits adaptive emotional expressions in parents. Mothers of children with acute myeloid leukemia and fathers of children with acute lymphoblastic leukaemia appear more distressed during the interview. This interview can be identified as an innovative technique of communication with parents of children with cancer.

Quality of life and psychosocial sequelae in children undergoing hematopoietic stem-cell transplantation: a review

This paper reviews the research published in the last 18 yr on QoL and psycho-social sequelae in pediatric patients who have undergone HSCT. A corpus of 47 empirical studies was selected and is presented here. From this selection five main topics linked to psychological adjustment to HSCT emerged: QoL; psychological symptoms; cognitive sequelae; social adaptation; psycho-social interventions for children. The information which emerged from the review of the literature is discussed with special attention to methodological issues. Directions for future research are proposed.

Parental narratives of quality of life in children with leukemia as associated with the placement of a central venous catheter

Thirty mothers of children with leukemia were interviewed about the child's and family's daily routines using a version of the Ecocultural Family Interview. Parental narratives were analyzed qualitatively and quantitatively. Four broad dimensions, encompassing 23 subthemes, were identified: child coping (alpha=0.88), child quality of life (alpha=0.72), parental coping (alpha=0.72), and parental trust in the medical care (alpha=0.73). Two objective variables were drawn from the medical charts (time from the diagnosis, time from central venous catheter [CVC] placement). Regression analyses showed that the number of days from the CVC placement (beta=0.46) and child coping (beta=0.44) significantly predicted children's quality of life, which in turn predicted parental trust in the medical care (beta=0.31). The methodological implications of our narrative approach are discussed.

Conversational strategies with parents of newly diagnosed leukaemic children: an analysis of 4880 conversational turns

GOALS OF WORK

Communication with parents of children newly diagnosed with cancer poses a number of problems, mostly due to the psychological effects of parental trauma. This study was designed to answer the following questions: How can we sustain the flow of communication with parents of children newly diagnosed with leukaemia so that it may become easier and more effective? What should we say to gather more reliable information from parents? How can we help empower their coping strategies?

PATIENTS AND METHODS

We analysed 4880 conversational turns in individual conversations carried out between psychologists and 21 parents of children with leukaemia. The conversations were aimed at gathering information of the families' daily routines. Dialogues were audiotaped and fully transcribed. The type and frequency of speech acts present in each turn were coded along 18 categories by two independent judges (inter-rater agreement, Cohen Kappa =0.73).

MAIN RESULTS

The parental speech acts expressing emotion in various ways go up to 58% of the total number of their speech acts. The lag-sequential analysis showed that such expressions are not associated with any of the interviewer's speech act. The same analysis showed that, by contrast, the interviewer's style has an effect upon the cognitive aspects of parents' conversation. Support of hope favoured parental ability to identify their coping strategies. Explicit requests, confirmations such as "sure" and key words summarizing parents' viewpoints are followed by parental factual and objective narratives.

CONCLUSIONS

Based on these results, a few practical recommendations for health care professionals are given in order to better communicate with parents of children newly diagnosed with cancer.

Immunomodulatory properties of a pineal indole hormone other than melatonin, the 5-methoxytryptophol

Several experiments have suggested that the pineal gland has an antitumor immunomodulatory action. Melatonin (MLT), the best known pineal hormone, has been shown to stimulate anticancer immune defenses during the night, corresponding to the period of its maximum blood levels, whereas it has no effect during the light phase of the day. At present, no study has been performed to investigate possible immunomodulating properties of other pineal indoles, such as 5-methoxytryptophol (5-MTL), whose circadian secretion would be opposite with respect to that of MLT, since it reaches its highest levels during the light phase of the day. In an attempt to analyze possible effects of 5-MTL on anticancer immunity, we have evaluated the action of 5-MTL (1 mg/ day orally at noon for 5 days) in 10 healthy volunteers on the two fundamental suppressive and immunostimulatory cytokines, consisting of IL-6 and IL-2, respectively. Serum levels of IL-2 and IL-6 were measured by an immunoradiometric method. Mean serum concentrations of IL-2 significantly increased on 5-MTL therapy, whereas those of IL-6 significantly decreased in response to 5-MTL. This preliminary study would suggest that the less known pineal indole 5-MTL, as well as MLT, has important immunomodulatory effects on cytokine secretions, including those involved in the antitumor immune response, by further confirming the essential role of the pineal as a central regulation of biological response modifier system. Several pineal alterations have been described in advanced cancer patients. According to the results of this study, the simultaneous administration of MLT during the dark phase and of 5-MTL during the light period of the day could further contribute to correcting pineal functions and to pilot the host anticancer immune reaction in an antitumor direction with respect to MLT alone.