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Kilfoy A, Panesar P, Hashemi E, Masama T, Pereira M, Liu W, Alexander S, Korenblum C, Jibb LA. "It just made me feel better": qualitative examination of the implementation of a novel virtual psychosocial support program for adolescents with cancer. Support Care Cancer 2023; 31:610. [PMID: 37792141 DOI: 10.1007/s00520-023-08054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Adolescents with cancer routinely report feelings of isolation and exclusion, including from medical decision-making. To address this problem and support adolescents, we designed and implemented the novel, virtual, weekly Teens4Teens peer support group and patient education program. We examined the views of participating adolescents, program guest speakers, and program moderators as they pertained to the need for the program, its feasibility, acceptability, and perceived impact. METHODS We recruited all available adolescents, moderators, and guest speakers who participated in Teens4Teens to take part in audio-recorded, semi-structured interviews. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS We conducted 21 interviews across participant groups. We identified four broad themes: pathways into the Teen4Teens program, Teens4Teens implementation capacity, perspectives of the positive impact of Teens4Teens, and suggestions to improve Teens4Teens. These themes described a perceived need for adolescent-centered psychosocial programming in pediatric cancer care, provided lessons on how best to build and apply such a program, and highlighted the value of the program for both adolescents' and clinicians' acceptability, feasibility, and perceived utility. CONCLUSION Adolescents, guest speakers, and moderators valued Teens4Teens and made suggestions to improve capacity to routinely implement the program. Adolescent-tailored psychosocial programming, such as Teens4Teens, is positioned to be integrated into clinical care with relative ease and may serve to improve the cancer care experience of adolescents and their families. This study has potential to provide researchers and clinicians with valuable information about the content, design, and delivery of virtual peer support programming for adolescents with cancer.
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Affiliation(s)
- A Kilfoy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - P Panesar
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, ON, Hamilton, L8S 4L8, Canada
| | - E Hashemi
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - T Masama
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
| | - M Pereira
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - W Liu
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - S Alexander
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, ON, Toronto, M5S 1A8, Canada
| | - C Korenblum
- Department of Supportive Care, University Health Network, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M6G 2C4, Canada
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, ON, Toronto, M5S 1A8, Canada
- Division of Adolescent Medicine, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada
| | - L A Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada.
- Division of Hematology and Oncology, Hospital for Sick Children, 170 Elizabeth St, Toronto, ON, M5G 1E8, Canada.
- Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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Abstract
PURPOSE To describe the costs and outcomes of palliative chemotherapy in women with recurrent and refractory ovarian cancer from the perspective of a health care provider. PATIENTS AND METHODS A retrospective study of 40 consecutive women who started second- or third-line chemotherapy for recurrent or refractory ovarian cancer between 1989 and 1992. Resource utilization from the commencement of second- or third-line chemotherapy until death or last follow-up evaluation was determined from a detailed chart review. All elements of care were recorded, including inpatient admissions, outpatient visits, chemotherapy drugs, nonchemotherapy drugs, radiation therapy, surgical procedures, investigations, and home care. Costs calculated using the hotel-approximation method are expressed in 1994 Canadian dollars. Actuarial estimates of cost and survival were used to account for censored observations. RESULTS After a minimum follow-up period of 24 months, 36 of 40 women had died. The median survival duration of the group was 1.1 years from study entry and 1.7 years from first relapse. The women received a median of two regimens of chemotherapy (range, one to four) from study entry. They spent a median of 33 days as hospital inpatients (mean, 46; range, 0 to 185); 58% of these inpatient days were for symptomatic management and 32% were for chemotherapy. The mean cost per patient was $53,000 (median, $36,600; range, $4,800 to $162,900). The relationship between cost and survival duration was not linear--the cost per year was lowest for those who lived longest. Inpatient admissions, chemotherapy drugs, and outpatient visits accounted for 62%, 21%, and 8% of the total cost, respectively. The total costs attributable to chemotherapy were $24,000 (45% of total costs) and the total costs attributable to supportive care were $23,000 (43% of total costs). CONCLUSION These data illustrate the cost of palliative management of recurrent and refractory ovarian cancer, which must be considered in the context of quality and duration of survival. They indicate the potential to improve cost efficiency by improving resource management, for example, by shifting from inpatient to outpatient chemotherapy, everything else being equal.
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Affiliation(s)
- C Doyle
- Department of Medicine, University of Toronto, Canada
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