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McNicol K, Salmon P, Young B, Fisher P. Alleviating Emotional Distress in a Young Adult Survivor of Adolescent Cancer. Clin Case Stud 2012. [DOI: 10.1177/1534650112461298] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A substantial proportion of adolescent and young adult cancer survivors experience persistent emotional distress, but little research has evaluated psychological interventions in this population. Metacognitive therapy (MCT), a transdiagnostic intervention, is an effective treatment for depression and a range of anxiety disorders in mental health settings, but its efficacy in cancer populations is unknown. This study used an AB design with 6-month follow-up to evaluate the potential efficacy of MCT for reducing symptoms of depression, anxiety, and posttraumatic stress in a young adult female survivor of adolescent leukemia. Clinician-rated and self-report measures demonstrated large, clinically meaningful, improvements on all outcome measures over seven treatment sessions, and these gains were maintained at 6-month follow-up. The case study demonstrates the potential applicability of MCT to treating emotional distress in young adult survivors of childhood cancer.
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Sansom-Daly UM, Wakefield CE, Bryant RA, Butow P, Sawyer S, Patterson P, Anazodo A, Thompson K, Cohn RJ. Online group-based cognitive-behavioural therapy for adolescents and young adults after cancer treatment: a multicenter randomised controlled trial of Recapture Life-AYA. BMC Cancer 2012; 12:339. [PMID: 22862906 PMCID: PMC3503656 DOI: 10.1186/1471-2407-12-339] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A cancer diagnosis is 2.9 times more likely to occur during the adolescent and young adult years than in younger children. This spike in incidence coincides with a life stage characterised by psychological vulnerability as young people strive to attain numerous, critical developmental milestones. The distress young people experience after cancer treatment seriously jeopardises their ability to move into well-functioning adulthood. METHODS/DESIGN This article presents the protocol of the Recapture Life study, a phase II three-arm randomised controlled trial designed to evaluate the feasibility and efficacy of a new intervention in reducing distress and improving quality of life for adolescent and young adult cancer survivors. The novel intervention, "ReCaPTure LiFe" will be compared to a both a wait-list, and a peer-support group control. Ninety young people aged 15-25 years who have completed cancer treatment in the past 1-6 months will be recruited from hospitals around Australia. Those randomised to receive Recapture Life will participate in six, weekly, 90-minute online group sessions led by a psychologist, involving peer-discussion around cognitive-behavioural coping skills (including: behavioural activation, thought challenging, communication and assertiveness skills training, problem-solving and goal-setting). Participants randomised to the peer-support group control will receive non-directive peer support delivered in an identical manner. Participants will complete psychosocial measures at baseline, post-intervention, and 12-months post-intervention. The primary outcome will be quality of life. Secondary outcomes will include depression, anxiety, stress, family functioning, coping, and cancer-related identity. DISCUSSION This article reviews the empirical rationale for using group-based, online cognitive-behavioural therapy in young people after cancer treatment. The potential challenges of delivering skills-based programs in an online modality are highlighted, and the role of both peer and caregiver support in enhancing the effectiveness of this skills-based intervention is also discussed. The innovative videoconferencing delivery method Recapture Life uses has the potential to address the geographic and psychological isolation of adolescents and young adults as they move toward cancer survivorship. It is expected that teaching AYAs coping skills as they resume their normal lives after cancer may have long-term implications for their quality of life. TRIAL REGISTRATION ACTRN12610000717055.
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Affiliation(s)
- Ursula M Sansom-Daly
- Centre for Children’s Cancer and Blood Disorders (CCC&BD), Level 1, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia
| | - Claire E Wakefield
- Centre for Children’s Cancer and Blood Disorders (CCC&BD), Level 1, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Phyllis Butow
- School of Psychology, Brennan MacCallum Building, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Susan Sawyer
- Centre for Adolescent Health, Royal Children’s Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | | | - Antoinette Anazodo
- Sydney Youth Cancer Service, Medical Professorial Unit, 1st Floor South Wing Edmund Blackett Building, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
| | - Kate Thompson
- OnTrac@PeterMac, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, Melbourne, VIC, 8006, Australia
| | - Richard J Cohn
- Centre for Children’s Cancer and Blood Disorders (CCC&BD), Level 1, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia
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Wakefield CE, Butow P, Fleming CAK, Daniel G, Cohn RJ. Family information needs at childhood cancer treatment completion. Pediatr Blood Cancer 2012; 58:621-6. [PMID: 21910212 DOI: 10.1002/pbc.23316] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/26/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite the recognized importance of information provision across the cancer trajectory, little research has investigated family information needs recently after childhood cancer. This mixed-methods, multiperspective, study explored the information needs of families of childhood cancer survivors in the first year post-treatment. PROCEDURE In total, 112 semi-structured telephone interviews were conducted with 19 survivors (mean age 16.2 years, off treatment for ≤36 months), 44 mothers, 34 fathers, and 15 siblings. Interviews were analyzed inductively, line-by-line, using the framework of Miles and Huberman. Emergent themes were cross-tabulated by sample characteristics using QSR NVivo8. RESULTS Participant views were mixed regarding the need for a "finishing treatment review" with their oncologist (the primary information source for most families); however, many mothers (29/44) and fathers (17/34) and most siblings (14/15) reported receiving insufficient information post-treatment. Information regarding fertility and how to prepare for likely post-treatment challenges were the most cited unmet needs. Online support was ranked highest by survivors (mean score: 7/2/10) and siblings (7.4/10), whilst parents preferred an information booklet (often due to concerns about accessing accurate and relevant information from the Internet). While many participants reported feelings of isolation/loneliness, many were reluctant to attend face-to-face support groups/seminars. CONCLUSIONS Family members of survivors may experience the most acute unmet needs for information about fertility and in preparation for post-treatment challenges. However, provision of the correct amount of information at the right time for each family member during a highly stressful period remains clinically challenging.
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Affiliation(s)
- Claire E Wakefield
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital (SCH), Randwick, New South Wales, Australia.
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Wakefield CE, McLoone JK, Fleming CA, Peate M, Thomas EJ, Sansom-Daly U, Butow P, Cohn RJ. Adolescent Cancer and Health-Related Decision-Making: An Australian Multi-Perspective Family Analysis of Appointment Attendance and Involvement in Medical and Lifestyle Choices. J Adolesc Young Adult Oncol 2011. [DOI: 10.1089/jayao.2011.0030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Claire E. Wakefield
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jordana K. McLoone
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Catharine A.K. Fleming
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michelle Peate
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Emily J. Thomas
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ursula Sansom-Daly
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Phyllis Butow
- School of Psychology, Sydney University, New South Wales, Sydney, Australia
| | - Richard J. Cohn
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, Randwick, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Love C, Sabiston CM. Exploring the links between physical activity and posttraumatic growth in young adult cancer survivors. Psychooncology 2011; 20:278-86. [DOI: 10.1002/pon.1733] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ladehoff N, Koch U, Mehnert A. Körperliche und psychosoziale Belastung bei Jugendlichen und jungen Erwachsenen mit einer Krebserkrankung. ACTA ACUST UNITED AC 2011. [DOI: 10.1026/0943-8149/a000036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Zielsetzung dieser Literaturanalyse ist die Erfassung des gegenwärtigen empirischen Erkenntnisstands zu den körperlichen und psychosozialen Belastungen bei Jugendlichen mit einer Krebserkrankung. Spezifische Fragestellungen beinhalten die Untersuchung der Art und der Auftretenshäufigkeit spezifischer Belastungen im körperlichen, psychischen und sozialen Bereich unter Berücksichtigung der krankheits- und behandlungsbezogenen Faktoren. Ziel ist es, den psychologischen und pädagogischen Unterstützungsbedarf sowie relevante Forschungsfragestellungen abzuleiten. Für den Suchzeitraum von 01/1986 bis 06/2009 konnten 33 Originalarbeiten in die Übersichtsarbeit einbezogen werden. Es wurden insgesamt 1751 Jugendliche mit einem Durchschnittsalter von 15.4 Jahren untersucht. Die Ergebnisse der Literaturanalyse zeigen, dass Jugendliche mit einer Krebserkrankung mit vielfältigen Belastungen konfrontiert sind, die alle elementaren Entwicklungsbereiche (physisch, psychisch, kognitiv und sozial) betreffen. Als besondere Belastungen zeigten sich in den Studien folgende Bereiche: die körperlichen Veränderungen, krebs- und behandlungsspezifische Erschöpfung (Fatigue) und die beeinträchtigte Lebensqualität, Ängste und Depression sowie ein verringertes Selbstwertgefühl, Sorgen, von den Freunden verlassen zu werden, Sorgen um verändertes Aussehen sowie darüber, die Schule zu versäumen. Als weiteres Ergebnis des Reviews kann festgehalten werden, dass für krebskranke Jugendliche der Aspekt Schule und Lernen einen großen Stellenwert einnimmt. Es besteht insgesamt ein großer Forschungsbedarf zu den psychosozialen und pädagogischen Unterstützungsbedürfnissen von jugendlichen Krebspatienten.
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Affiliation(s)
- Natalie Ladehoff
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Uwe Koch
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - Anja Mehnert
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
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Seitz DCM, Hagmann D, Besier T, Dieluweit U, Debatin KM, Grabow D, Kaatsch P, Henrich G, Goldbeck L. Life satisfaction in adult survivors of cancer during adolescence: what contributes to the latter satisfaction with life? Qual Life Res 2010; 20:225-36. [PMID: 20844965 DOI: 10.1007/s11136-010-9739-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the general and health-related life satisfaction (LS) in long-term survivors of adolescent cancer with a community sample and to identify medical and psychosocial factors associated with LS. METHODS LS of 820 survivors (age M = 30.4 ± 6.0 years; time since diagnosis M = 13.7 ± 6.0 years) was assessed with the Questions on Life Satisfaction (FLZ(M)) and compared to an age- and sex-matched community sample. The effects of medical, psychological, and socio-demographical factors on the survivors' general and health-related LS were investigated by means of multiple regression analyses. RESULTS Survivors were significantly less satisfied than the comparison group in terms of both their general (P < .001, d = -.35) and health-related (P < .001, d = -.47) life. Somatic late effects, symptoms of depression and anxiety, and less posttraumatic growth were associated with impaired general and health-related LS. Moreover, being married contributed significantly to higher general LS. CONCLUSION Adult survivors of cancer with onset during adolescence are experiencing less LS than the general population. Long-term routine follow-up visits are recommended to identify persisting effects of cancer survival on LS and to provide support for those with special needs. Physicians need to pay special attention to potential risk factors such as psychological distress, somatic late effects, persistent psychological distress, and a lack of posttraumatic growth, which are negatively correlated with LS.
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Affiliation(s)
- Diana C M Seitz
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhövelstrasse 5, 89075, Ulm, Germany.
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Seitz DCM, Besier T, Debatin KM, Grabow D, Dieluweit U, Hinz A, Kaatsch P, Goldbeck L. Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence. Eur J Cancer 2010; 46:1596-606. [PMID: 20381339 DOI: 10.1016/j.ejca.2010.03.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 02/04/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND To determine the prevalence of posttraumatic stress, depression and anxiety in adults who have survived cancer (5 years) diagnosed in adolescence, as compared to healthy controls. PATIENTS AND METHODS Survivors (n=820) of cancer during adolescence (age M=30.4+/-6.0 years; M=13.7+/-6.0 years since diagnosis) and 1027 matched controls without history of cancer (age M=31.5+/-6.9 years) completed standardised questionnaires measuring posttraumatic stress, depression and anxiety. Additionally, sub-groups of 202 survivors and 140 controls with elevated scores received structured interviews to ascertain DSM-IV-diagnoses. RESULTS A total of 22.4% of the survivors reported clinically relevant symptoms of posttraumatic stress, anxiety and/or depression compared to 14.0% of the controls (odds ratios [ORs] 1.77; 95% confidence interval [CI] 1.39-2.26). The odds of posttraumatic stress symptoms in male (OR 3.92, 95% CI 1.80-8.51) and female (OR 3.83, 95% CI 2.54-5.76) survivors were more than three times those in the controls. However, only female survivors reported symptoms of depression and anxiety significantly more often (respectively: OR 2.12, 95% CI 1.16-3.85; and OR 1.86, 95% CI 1.33-2.59) than the controls. A relevant subgroup of 24.3% of the survivors met DSM-IV criteria for at least one mental disorder compared to 15.3% of the controls. CONCLUSION Survivors of cancer during adolescence show an elevated risk of presenting symptoms of posttraumatic stress, anxiety and/or depression during adulthood which is also reflected in a greater number of DSM-IV diagnoses when compared to controls. Comprehensive follow-up assessments should include the examination of possible psychological late effects of a cancer diagnosis in adolescence in order to identify survivors needing psychosocial interventions even years after the completion of successful medical treatment.
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Affiliation(s)
- Diana C M Seitz
- University Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Steinhövelstrasse 5, D-89075 Ulm, Germany.
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