Parents' experience of cancer who have young children: a literature review

Love, faith and hope - a secondary analysis of prostate cancer survivors and their partners

BACKGROUND

Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention.

DESIGN

In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population.

RESULTS

This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.

The adolescent's experience when a parent has advanced cancer: A qualitative inquiry

BACKGROUND

Parental cancer is a stressful experience for young people, constituting a potential threat to physical and mental health and normative development. Currently, there is insufficient information describing the sources and nature of this distress during advanced parental cancer, especially concerning families with adolescent children.

AIM

To address the significant gap in the literature by providing the adolescent's perspective on the impact of their parent's advanced cancer on their lives.

DESIGN

This qualitative study involved single-occasion, semi-structured elicitation interviews with adolescents whose parents were diagnosed with advanced stage cancer.

SETTING/PARTICIPANTS

The study sample consisted of seven adolescents from six families, five females and two males ranging in age from 11 to 15 years (mean = 13.6 years, standard deviation = 1.4 years). The ill parents consisted of four females and two males diagnosed with Stage IV cancer.

RESULTS

The core construct that organized study results was Weaving a Normal Life with Cancer which involved five major domains: feeling the weight of the world on my shoulders; cancer changes everything; confronting or getting away from the cancer; talking about it; and cancer was a positive for me … it taught me.

CONCLUSION

Study findings shed light on how adolescents self-manage their parent's advanced cancer and work to delimit the illness even as they are aware of its constant presence. Future research and intervention studies are needed to support and add to the adolescents' self-management strategies to weave a normal life for themselves while in the throes of the cancer's uncertainty and challenges with family communication.

Teenagers want to be told when a parent's death is near: A nationwide study of cancer-bereaved youths' opinions and experiences

BACKGROUND

We aimed to investigate cancer-bereaved youths' opinions and experiences of being told about a parent's imminent death from cancer and of barriers to this communication.

MATERIAL AND METHODS

This nationwide population-based survey included 622/851 (73%) youths (aged 18-26) who at age 13-16, 6-9 years earlier had lost a parent to cancer.

RESULTS

In total 595 of 610 (98%) of the participants stated that teenage children should be informed when the parent's death was imminent (i.e. a matter of hours or days, not weeks). 59% stated that they themselves had been told this, 37% by the parents, 7% by parents and healthcare professionals together and 8% by professionals only. Frequent reasons for why the teenager and parents did not talk about imminent death before loss were that one (n=106) or both (n=25) of the parents together with the teenage child had pretended that the illness was not that serious, or that none of the parents had been aware that death was imminent (n=80). Up to a couple of hours before the loss, 43% of participants had not realized that death was imminent.

CONCLUSION

In this population-based study virtually all youth who at ages 13-16 had lost a parent to cancer afterwards stated that teenagers should be told when loss is near, i.e. a matter of hours or days, not weeks. Many stated that they had not been given this information and few were informed by professionals, with implications for future improvements in end-of-life care of patients with teenage children.

Cancer-related worry in Canadian thyroid cancer survivors

CONTEXT

Little is known about cancer-related worry in thyroid cancer survivors.

OBJECTIVES

We quantified cancer-related worry in Canadian thyroid cancer survivors and explored associated factors.

DESIGN, SETTING, AND PARTICIPANTS

We performed a cross-sectional, self-administered, written survey of thyroid cancer survivor members of the Thyroid Cancer Canada support group. Independent factors associated with cancer-related worry were identified using a multivariable linear regression analysis.

MAIN OUTCOME MEASURE

We used the Assessment of Survivor Concerns (ASC) questionnaire, which includes questions on worry about diagnostic tests, second primary malignancy, recurrence, dying, health, and children's health.

RESULTS

The response rate for eligible members was 60.1% (941 of 1567). Most respondents were women (89.0%; 837 of 940), and the age was < 50 years in 54.0% of participants (508 of 941). Thyroid cancer was diagnosed within ≤ 5 years in 66.1% of participants (622 of 940). The mean overall ASC score was 15.34 (SD, 4.7) (on a scale from 6 [least worry] to 24 [most worry]). Factors associated with increased ASC score included: younger age (P < .001), current suspected or proven recurrent/persistent disease (ie, current proven active disease or abnormal diagnostic tests) (P < .001), partnered marital status (P = .021), having children (P = .029), and ≤5 years since thyroid cancer diagnosis (P = .017).

CONCLUSIONS

In a population of Canadian thyroid cancer survivors, cancer-related worry was greatest in younger survivors and those with either confirmed or suspected disease activity. Family status and time since thyroid cancer diagnosis were also associated with increased worry. More research is needed to confirm these findings and to develop effective preventative and supportive strategies for those at risk.

Talking About Maternal Breast Cancer With Young Children: A Content Analysis of Text in Children's Books

OBJECTIVE

Examine the content of children's books and summarize the main issues related to communication with young children about maternal cancer, especially breast cancer.

METHODS

A search of English books discussing early-stage (breast) cancer and written for children aged 3-12 years was conducted on the Amazon.com Web site. Each of 45 identified books was analyzed independently by two of three coders using inductive qualitative content analysis.

RESULTS

The main contents of these books included cancer-related knowledge, impacts of maternal cancer, and coping strategies. The concept of (breast) cancer and its treatment was introduced in plain language and some common misunderstandings were clarified. The consequences of maternal cancer were highlighted.

CONCLUSIONS

These books are beneficial to children and adults. However, impacts on school life, children's concerns about financial burdens, and instructions about age-appropriate use of the books have been neglected. Additional studies should be undertaken to explore the value of these books.

[Teenage and young adult cancer: how to make effective disclosures?]

Announcement of diagnosis is a critical step in establishing a trust-based relationship of quality between patient and physician. Disclosing "bad news" is a difficult and sensitive task which has direct consequences on psychological, emotional and relational levels, as well as on therapeutic management. This is a potentially traumatic experience which requires a long process of integration and psychological adaptation. The hematologist-oncologist occupies a central position: He introduces the framework for a multidisciplinary care, while taking into account the personality and behavior of the teenager or young adult. We propose an analysis of doctor-patient interaction; an overview of psychological issues associate with diagnosis disclosure; suggestions to build and manage communication with patients; and a clarification of the role of the psychologist and of the psychological adjustment at the time of disclosure.

Does a parental history of cancer moderate the associations between impaired health status in parents and psychosocial problems in teenagers: a HUNT study

Severe disease in a parent is associated with increased psychosocial problems in their children. However, moderating factors of such associations are less studied. In this cross-sectional population-based controlled study we examined the moderating effects of a history of parental cancer on the association between impaired health status in parents and psychosocial problems among their teenagers. Among families with both parents responding to the adult Health Survey of Nord-Trøndelag County of Norway (the HUNT-2 study) 71 couples were identified with primary invasive cancer in one parent. Their 81 teenage children took part in the Young-HUNT study. These families were compared to 322 cancer-free families with 328 teenagers. Based on self-report data the relations between three variables of parental impaired health and six psychosocial problems in teenagers were analyzed family wise by structural equation modeling. Significant associations between parental and teenagers' variables were observed in eight of 18 models. A history of parental cancer was a significant moderator which decreased four of eight significant associations. Such a history significantly weakened the associations between parental poor self-rated health and teenagers' anxiety/depression and school problems. A similar association of a history of parental cancer was found between psychological distress in parents and teenagers' feelings of loneliness and poor self-rated health. This study confirmed strong associations between impaired parental health and psychosocial problems in their teenagers. A history of parental cancer weakened several of the significant associations between parental impaired health variables and psychosocial problems in their teenagers.

Social support for South Asian Muslim parents with life-limiting illness living in Scotland: a multiperspective qualitative study

OBJECTIVE

To explore experiences of social support needs among South Asian Muslim patients with life-limiting illness, living in Scotland, who are parents of young children.

DESIGN

Secondary analysis of data from a multiperspective, longitudinal Scottish study involving in-depth semistructured interviews with patients, their nominated carers and healthcare professionals. Data were analysed using interpretive phenomenological analysis.

SETTING

Edinburgh, Scotland.

PARTICIPANTS

South-Asian Muslim patients with life-limiting illness with children under the age of 18 (n=8), their carer (n=6) and their healthcare professional.

MAIN OUTCOME MEASURES

Access and provision of social support in palliative care.

RESULTS

Open-ended qualitative interviews identified four main themes: (1) parental sadness over being unable to provide tangible support; (2) parental desire to continue to provide emotional support; (3) limited availability of informal social support networks; and (4) differing perspectives between healthcare professionals and patients on patient access to social support sources, with a subtheme being the capacity of male carers to provide social support. South-Asian parents at the end of life had limited access to extended-network support. Gender roles appeared as challenging for healthcare providers who at times overestimated the amount of support a female carer could provide and underestimated the amount of support male carers provided. Implications for practice include the need for greater awareness by healthcare providers of the social support needs of ethnic minority and migrant parents with life-limiting illnesses and especially an awareness of the importance of the role of male and female carers. Further research is needed to explore how the timing of migration impacts the need for and availability of tangible and emotional informal social support among ethnic minority parents with life-limiting illness.

The impact of motherhood on perceived stress, illness intrusiveness and fear of cancer recurrence in young breast cancer survivors over time

OBJECTIVE

Parenting while coping with breast cancer can be challenging for many young women, yet little is known about the impact of motherhood on their well-being over time.

DESIGN

The first part of this study examined differences in perceived stress, illness intrusiveness and fear of cancer recurrence between young breast cancer survivors with and without children in two separate time frames (0-5 and 5-15 years since diagnosis). The second part identified determinants for these elements of well-being in young mothers exclusively.

MAIN OUTCOME MEASURES

Seven hundred and forty two young North American women previously diagnosed with breast cancer completed measures of perceived stress, illness intrusiveness, fear of cancer recurrence and parenting stress (mothers only) via a web-based survey.

RESULTS

Compared to young survivors without children, young mothers reported higher levels of fear of cancer recurrence and illness intrusiveness in intimate life domains during both time frames. Part 2 revealed how maternal age, age of children, time since diagnosis and parenting stress impacted on well-being in this group.

CONCLUSIONS

Young mothers with breast cancer need support to manage their fears of having a recurrence and to cope with problems in intimacy well into remission. This study identifies the most vulnerable groups of mothers.

The impact of a breast cancer diagnosis in young women on their relationship with their mothers

BACKGROUND

For young women with breast cancer mothers might either be a source of support or of increased stress, depending on the premorbid relationship and on the psychological effect of the daughter's diagnosis on her mother.

OBJECTIVES

To examine the effects of a breast cancer diagnosis on young women's relationships with their mothers and the possible support needs of these mothers from the daughters' perspective.

PATIENTS AND METHODS

We developed and pre-tested a self-administered questionnaire on 10 survivors of breast cancer diagnosed ≤ age 40. Then, consecutive recurrence-free young women diagnosed with breast cancer were asked to complete the modified questionnaire.

RESULTS

Of 110 daughters approached from July/11 to May/12, 90 (82%) participated. In 11 cases (13%), the daughters had turned to their mothers before approaching anyone else. Of the 83 daughters who disclosed their diagnosis to their mothers, 76 (92%) stated their mothers had been emotionally and/or practically supportive, and 43 (54%) reported that the breast cancer diagnosis had a favorable impact on their relationship with their mothers. Of the 35 employed mothers, 26 had taken time off from work to support their daughters. Nineteen mothers, eight of whom had been living in a different country, had slept over or moved in with daughters during their treatment. Twenty-two daughters believed their mothers felt responsible to some extent for their developing breast cancer. Fifty-nine daughters indicated that health care professionals could help mothers by providing information pamphlets, education sessions, and linking to support groups.

CONCLUSION

Mothers are an important source of support for young daughters with breast cancer, with the mother-daughter relationship frequently becoming closer after the diagnosis. However, the practical and emotional burden on mothers appears to be high. Future studies should address the effects of a breast cancer diagnosis in young daughters from the mothers' perspective, and the benefit of formal supports for these mothers.

Balance artistry: the healthy parent's role in the family when the other parent is in the palliative phase of cancer--challenges and coping in parenting young children

OBJECTIVES

The aim of this review was to provide a systematic overview of knowledge on how advanced cancer in a parent impacts the healthy parent's role in a family with children aged 6-12 years, and the types of help that they require in order to cope. Despite the large number of families living with a parent affected by cancer, the literature is limited concerning the needs and outcomes for the healthy parents and their need for support in managing their children's needs, when the partner is seriously ill or is in the palliative phase of cancer.

METHOD

Comprehensive literature searches were undertaken by systematically searching for qualitative articles published during the period 1989-2009. The quality assessment was evaluated using a predefined "checklist to assess qualitative research."

RESULTS

Seven articles met our eligibility criteria. Four distinct themes emerged that describe the healthy parent's role in the family, whose life is now characterized by uncertainty and who is attempting to maintain a balance between the needs of their children, the patient, and themselves: (1) new roles without a script, (2) attempting to maintain a safe and normal life, (3) feeling alone even within the family, and (4) support to help young family members.

SIGNIFICANCE OF RESULTS

The present review provides new knowledge and insight into how healthy parents manage the challenges in parenting young children, coping with their everyday lives, and taking on new roles when their partner has advanced cancer or is dying. The healthy parent cannot balance the needs of all family members. To reach the goals of palliative care, nurses and other health professionals are encouraged to offer the patient, the healthy parent, and the children practical and emotional support.

Enhancing the social well-being of family caregivers

OBJECTIVES

To provide an overview of key issues and resources useful for oncology professionals to support the social well-being of patients and their families. A caregiver narrative highlights examples of the importance of addressing the social impact of illness.

DATA SOURCES

Review of the literature and Web sites related to social well-being of oncology patients and families.

CONCLUSION

Culture influences social well-being and impacts caregiving across the life span. Coping with cancer creates a myriad of social implications with potentially significant impacts on communication; sexuality, intimacy and sexual expression; education, finances, work, and leisure.

IMPLICATIONS FOR NURSING PRACTICE

Nurses spend the greatest amount of time with patients and their families and therefore have an especially important role in identifying and addressing social needs. An interdisciplinary approach to care that includes the assessment of those at high risk and family meetings increases opportunities to address the complex multidimensional social concerns associated with oncology care.

The European Society of Breast Cancer Specialists recommendations for the management of young women with breast cancer

EUSOMA (The European Society of Breast Cancer Specialists) is committed to writing recommendations on different topics of breast cancer care which can be easily adopted and used by health professionals dedicated to the care of patients with breast cancer in their daily practice. In 2011, EUSOMA identified the management of young women with breast cancer as one of the hot topics for which a consensus among European experts was needed. Therefore, the society recently organised a workshop to define such recommendations. Thirteen experts from the different disciplines met for two days to discuss the topic. This international and multidisciplinary panel thoroughly reviewed the literature in order to prepare evidence-based recommendations. During the meeting, two working groups were set up to discuss in detail diagnosis and loco-regional and systemic treatments, including both group aspects of psychology and sexuality. The conclusions reached by the working groups were then discussed in a plenary session to reach panel consensus. Whenever possible, a measure of the level of evidence (LoE) from 1 (the highest) to 4 (the lowest) degree, based on the methodology proposed by the US Agency for Healthcare Research and Quality (AHRQ), was assigned to each recommendation. The present manuscript presents the recommendations of this consensus group for the management of young women with breast cancer in daily clinical practice.

How do we talk to the children? Child life consultation to support the children of seriously ill adult inpatients

BACKGROUND

Families with young children often struggle to talk about and cope with a parent's life-threatening illness and potential death. Adult interdisciplinary palliative medicine teams often feel unprepared to facilitate the open communication with these children that has been shown to reduce anxiety, depression, and other behavioral problems. In pediatric settings, child life specialists routinely provide this support to hospitalized children as well as their siblings and parents. Although these services are the standard of care in pediatrics, no research reports their use in the care of children of adults with serious illness.

OBJECTIVE

Our aim is to describe a pilot child life consultation service for the children of seriously ill adult inpatients.

DESIGN

We summarize the support needs of these children, their families, and the medical staff caring for them and report our experience with developing a child life consultation service to meet these needs.

SETTING/SUBJECTS

Our service assists seriously ill adult inpatients and their families in a university medical center.

RESULTS

Informal feedback from families and staff was uniformly positive. During consultations, family and child coping mechanisms were assessed and supported. Interventions were chosen to enhance the children's processing and self-expression and to facilitate family communication.

CONCLUSION

All hospitals should consider providing broad-based in-service training enabling their staff to improve the support they offer to the children of seriously ill parents. Medical centers with access to child life services should consider developing a child life consultation service to further enhance this support. More research is needed to evaluate both the short- and long-term clinical impact of these interventions.

Cancer's unequal impact on incomes in Norway

BACKGROUND

At a group level, cancer results in reduced labor earnings. Public benefits common to welfare states may, however, compensate for all or parts of the decline in earnings. Norwegian cancer survivors' incomes, including both labor earnings and compensatory welfare benefits, were compared to those of the cancer-free population to assess potential welfare consequences of cancer. Possible modifying effects of parental and marital status, education, prior earnings and age were assessed in depth.

MATERIAL AND METHODS

Log-linear regression models were used to estimate incomes across different sociodemographic variables using register data covering the entire Norwegian population 40-59 years old with any income in 2008, 536 600 men and 502 500 women, of whom more than 17,000 were diagnosed with cancer in 2000-2007.

RESULTS

Compared to the cancer-free general population, cancer was associated with a modest 7% decline in incomes overall. The decline was, however, significantly associated with sociodemographic factors, marital status exempted. Childless men with low education and low prior earnings were most adversely affected. Lymphomas and lung cancer accounted largely for these unfavorable effects.

CONCLUSIONS

Declines in earnings after cancer are to a large degree compensated by the Norwegian welfare state, and incomes overall are only modestly decreased among cancer survivors compared to the general population. Persons with multiple unfavorable sociodemographic characteristics experience particularly low incomes after cancer. This is of concern in a supposedly egalitarian society with public health care and antidiscrimination acts in place. Welfare state interventions, i.e. work reintegration efforts and/or compensations for labor earning drops, directed specifically towards these subgroups might be warranted.

Lebanese parents' experiences with a child with cancer

BACKGROUND

The impact of childhood cancer on the family has been studied in different cultures and continues to be an object of study and concern, In Lebanon, a country of 4 million people 282 new pediatric cases of cancer age <20 years diagnosed in 2004 were reported in 2008.

OBJECTIVES

The purpose of this study was to explore the experiences of Lebanese families living with a child with cancer.

METHOD

The study followed purposeful sampling in which 12 parents (mother or father) of a child with cancer were interviewed. Data were analyzed following the hermeneutical process as described by Diekelmann and Ironsides (1998).

RESULTS

A constitutive pattern "It is a continuous battle" and five themes emerged from the data analysis. Living with the shock of the diagnosis; Alterations in the quality of the family's life; Living with added burdens; Disease impact on the family and sibling dynamics; Living with uncertainty represent the major themes that emerged from the participants' experiences while living with a child with cancer.

CONCLUSION

The study contributes to the knowledge that would help health care professionals understand the experiences and challenges that are faced by Lebanese families living with a child with cancer. This awareness would serve as a basis for health care professionals in general and nurses in particular to understand parents' experiences, and offer support, elicit communication of feelings, and examine possibilities for forming a partnership during the challenging course of the child's illness. Supported parents are more likely to provide more effective care to their child with cancer.

Children and young adults with parents with cancer: a population-based study

Background

Today many people are choosing to have children later in life. Additionally, the use of sophisticated diagnostic tools and screening modalities has increased over recent years. Because of these factors, cancer is being diagnosed more frequently during the child-rearing years. Sociodemographic and cancer-related information on families and minor (0–18 years) and young adult (YA) (19–25 years) children experiencing parental cancer is scarce, but this information is vital for healthcare initiatives aimed toward those potentially adversely affected. Therefore, the aim of this study was to describe features of families and minor and YA children affected by parental cancer in a nationwide population.

Methods

Complete Norwegian birth cohort data were obtained from national registries. Descriptive prevalence and incidence statistics were collected for parents and minor and YA children. Logistic regression models were used to assess factors likely to influence parental death.

Results

Every year around 0.3% of all families with children under the age of 18 years encounter parental cancer, and 3.1% of minors and 8.4% of YAs have a parent who has been diagnosed with cancer. This study found skin, breast, testicular, and colorectal cancers were the most common forms of cancer diagnosed. The sociodemographic features of those affected were fairly similar to those of the general population. One in five children experienced parental death from cancer; parental death was more often paternal than maternal and was most common in parents diagnosed with leukemia or brain, colorectal, and lung tumors. Deaths are uncommon among parents without cancer.

Conclusion

Adequate assistance for minor and YA children affected by parental cancer requires knowledge of their number and characteristics. Parental cancer is more common than previously suggested: the annual incidence of parental cancer for children under 18 years of age is 0.3%, whereas approximately 4% of children aged 0–25 years have or have had parents diagnosed with cancer, corresponding to a population prevalence of 1.4%. Around 20% of these children experience parental death, and surveys of live respondents should account for this.

[Children as relatives of seriously ill and dying patients]

For children, the diagnosis of a serious disease of near relatives is a dramatic experience, particularly when their parents are involved. Such a situation demands great efforts to cope with. Therefore these children have an increased risk of developing mental health problems. To prevent this, children and adolescents need support according to their personal developmental stage. Above all it is necessary to give support to the parents, as their expertise as father and mother provides stability for their children. All interventions aim at one goal, which is maintaining the stability of the family. In the following, results of studies will be discussed with respect to the case report. According to the European research project "COSIP" (Children of Somatically Ill Parents) a recommendation for medical doctors of all specialities, caring for adults with severe diseases, should be lined out.

Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding

PURPOSE

The goal of this study was to assess the rehabilitation needs of young women breast cancer survivors under the age of 50 and to identify factors that may impact or prevent cancer rehabilitation utilization.

METHODS

Utilizing a grounded theory methodology, 35 young breast cancer survivors were interviewed twice in four Atlantic Canadian provinces.

RESULTS

A considerable number of barriers exist to receiving rehabilitative care post-treatment for young breast cancer survivors. The systemic barriers include the lack of availability of services, travel issues, cost of services, and the lack of support to address the unique needs for this age group. However, the most complicated barriers to accessing rehabilitative care were personal barriers which related more to choice and circumstances, such as the lack of time due to family responsibilities and appointment fatigue. Many of these personal barriers were rooted in the complex set of gender roles of young women as patients, mothers, workers, and caregivers.

CONCLUSIONS

The contexts of young women's lives can have a substantial impact on their decisions to seek and receive rehabilitative care after breast cancer treatment. The systemic barriers can be reduced by introducing more services or financial assistance; however, the personal barriers to rehabilitation services are difficult to ameliorate due to the complex set of roles within and outside the family for this group of young breast cancer survivors. Health care providers need to take into consideration the multiple contexts of women's lives when developing and promoting breast cancer rehabilitation services and programs.

Being in suspense: women's experiences awaiting breast cancer surgery

AIM

This article is a report of a qualitative study of women's experiences after having received a breast cancer diagnosis and awaiting primary surgery.

BACKGROUND

Breast cancer is experienced as an important stressor and a major challenge. How women appraise the diagnosis affects their postsurgery adaptation. Although studies have documented the presurgery period as stressful, in-depth understanding of women's experiences while awaiting surgery studied during this stressful period is still needed.

METHOD

Twenty-one women with newly diagnosed breast cancer were interviewed individually the day before surgery at a Norwegian university hospital, between February 2006 and February 2007. Interviews were analysed using the qualitative meaning condensation method.

FINDINGS

Feeling healthy, but having to adapt to disease, waiting, uncertainty, having to tell and existential awareness were themes identified. Having to wait was experienced as frightening, painful, long and difficult - but also necessary. Some expressed apprehension because they could not do anything about their situation. Others emphasized that it was good to have some time between diagnosis and surgery to become personally prepared and spend time with loved ones. Informing others about the diagnosis was a great burden for most of them. Social networks could both give and crave support.

CONCLUSION

Healthcare professionals need to be sensitive to the individual experiences of women awaiting breast cancer surgery to give support to ease their situation. Setting the date for surgery will alleviate anxiety. Follow-up studies about the potential impact of presurgery experiences on later experiences of living with breast cancer and intervention studies are needed.

Malignant hematologic diseases in adolescents and young adults

Adolescents and young adults (AYA) with cancer have been designated as a vulnerable population by the National Cancer Institute. This group, defined by the ages of 16-39 years, has not enjoyed the same survival improvements over the past several decades as older and younger cohorts. Several barriers prevent the optimal delivery of oncologic care in this subpopulation. This review will describe these challenges in the context of the major hematologic malignancies affecting this population (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], Hodgkin lymphoma [HL], and non-Hodgkin lymphoma [NHL]). For example, historical differences in care delivery between pediatric and adult health care systems have created confusion about optimal treatment planning for AYAs, a population that spans the pediatric-adult divide. In the case of ALL, retrospective studies have demonstrated significantly better outcomes when AYAs are treated according to pediatric and not adult protocols. Additional challenges more specific to AYAs include increased treatment-related toxicity relative to younger patients; less access to care and, specifically, access to clinical trials; lower adherence to medications and treatment plans; and psychosocial stressors relevant to individuals at this stage of life. Recognizing and responding to these challenges in AYAs may create opportunities to improve the cancer outcomes of this group.

Validation of a self-concept scale for Lynch syndrome in different nationalities

Learning about hereditary cancer may influence an individual's self-concept, which otherwise represents a complex but stable cognitive structure. Recently, a 20-statement self-concept scale, with subscales related to stigma-vulnerability and bowel symptom-related anxiety, was developed for Lynch syndrome. We compared the performance of this scale in 591 mutation carriers from Denmark, Sweden and Canada. Principal component analysis identified two sets of linked statements-the first related to feeling different, isolated and labeled, and the second to concern and worry about bowel changes. The scale performed consistently in the three countries. Minor differences were identified, with guilt about passing on a defective gene and feelings of losing one's privacy being more pronounced among Canadians, whereas Danes more often expressed worries about cancer. Validation of the Lynch syndrome self-concept scale supports its basic structure, identifies dependence between the statements in the subscales and demonstrates its applicability in different Western populations.