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Rao P, Segel JE, Bingen K, Devine KA, Rumbaugh CL, Costigan HJ, Dandekar S, Wasserman E, Koehly LM, Blackall GF, Rakszawski K, Songdej N, Verdery AM, Lengerich EJ, Van Scoy LJ. Educational and occupational aspirations of adolescent and young adult cancer survivors: a qualitative analysis. Support Care Cancer 2024; 32:572. [PMID: 39105828 DOI: 10.1007/s00520-024-08761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Adolescent and young adult cancer survivors (AYACS) are patients diagnosed with cancer between 15 and 39 years of age. AYACS are often derailed from planned educational and occupational endeavors due to disruption from cancer treatment and its consequences. The study objective was to examine how a personal cancer diagnosis impacted AYACS' experiences related to these endeavors. METHODS Semi-structured interviews were conducted as part of a larger study assessing psychosocial challenges among a younger AYACS subset aged 15-25 years old at the time of cancer diagnosis. Interviews were coded based on responses and were used to develop themes related to educational and occupational endeavors. RESULTS Data were collected from 35 participants. Five themes emerged: (1) Pauses in educational attainment had a detrimental effect on educational goals for some participants, but further solidified and sculpted educational plans for others; (2) Although participants experienced challenges accomplishing educational goals, supportive school environments helped surmount these challenges; (3) Participants reflected on rethinking career aspirations, though some desired to pursue the same occupation planned before cancer diagnosis; (4) Participants experienced challenges, including physical and cognitive limitations, upon returning to work; and (5) Participants valued autonomy and normalcy through work and appreciated supportive and flexible work environments. CONCLUSIONS AYACS prioritize professional achievement, yet encounter challenges in achieving professional goals. Our findings create a foundation for developing and testing prospective interventions to promote continuance of school and work during cancer treatment when feasible, and proactive reintegration strategies for those who paused professional goals due to cancer treatment.
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Affiliation(s)
- Pooja Rao
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA, USA.
| | - Joel E Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
- Penn State Cancer Institute, Hershey, PA, USA
| | - Kristin Bingen
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Smita Dandekar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA, USA
| | | | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - George F Blackall
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA, USA
| | | | | | - Ashton M Verdery
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, USA
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA, USA
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Edward J, Northrip KD, Rayens MK, Welker A, O’Farrell R, Knuf J, Fariduddin H, Costich J, D’Orazio J. Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers. JNCI Cancer Spectr 2024; 8:pkae025. [PMID: 38552323 PMCID: PMC11087728 DOI: 10.1093/jncics/pkae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. METHODS We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. RESULTS In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. CONCLUSIONS Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. CLINICALTRIALS.GOV REGISTRATION NCT05876325.
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Affiliation(s)
- Jean Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kimberly D Northrip
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Andrea Welker
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Rachel O’Farrell
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Jennifer Knuf
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Haafsah Fariduddin
- Markey STRONG, Markey Cancer Center, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Julia Costich
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - John D’Orazio
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
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Ohlsen TJD, Wang H, Buchbinder D, Huang IC, Desai AD, Zheng Z, Kirchhoff AC, Park ER, Krull K, Conti RM, Yasui Y, Leisenring W, Armstrong GT, Yabroff KR, Nathan PC, Chow EJ. Financial hardship among siblings of long-term survivors of childhood cancer: A Childhood Cancer Survivor Study report. Cancer 2024; 130:1125-1136. [PMID: 38100563 PMCID: PMC10939878 DOI: 10.1002/cncr.35150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Siblings of children with cancer may experience adverse household economic consequences, but their financial outcomes in adulthood are unknown. METHODS A total of 880 siblings (aged 18-64 years) of adult-aged childhood cancer survivors were surveyed to estimate the prevalence of financial hardship by three established domains (behavioral, material, and psychological). For individual financial hardship items matching the contemporaneous National Health Interview Survey or Behavioral Risk Factor Surveillance System, siblings were compared with the general population by calculating adjusted prevalence odds ratios (ORs) to sample-weighted responses. Multivariable logistic regression models examined associations between sibling characteristics and each hardship domain and between sibling hardship and survivors' cancer/treatment characteristics. RESULTS Behavioral, material, and psychological hardship was reported by 24%, 35%, and 28%, respectively. Compared with national survey respondents, siblings were more likely to report worries about medical bills (OR, 1.14; 95% confidence interval [CI], 1.06-1.22), difficulty affording nutritious foods (OR, 1.79; 95% CI, 1.54-2.07), and forgoing needed medical care (OR, 1.38; 95% CI, 1.10-1.73), prescription medications (OR, 2.52; 95% CI, 1.99-3.20), and dental care (OR, 1.34; 95% CI, 1.15-1.57) because of cost. Sibling characteristics associated with reporting financial hardship in one or more domains included female sex, older age, chronic health conditions, lower income, not having health insurance, high out-of-pocket medical expenditures, and nonmedical/nonhome debt. No survivor cancer/treatment characteristics were associated with sibling financial hardship. CONCLUSIONS Adult siblings of childhood cancer survivors were more likely to experience financial hardship compared with the general population. Childhood cancer may adversely affect entire households, with potentially lasting implications.
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Affiliation(s)
- Timothy J. D. Ohlsen
- Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Huiqi Wang
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - I-Chan Huang
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Arti D. Desai
- Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
| | | | - Anne C. Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kevin Krull
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Rena M. Conti
- Questrom School of Business, Boston University, Boston, MA, USA
| | - Yutaka Yasui
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | | | | | - Paul C. Nathan
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Eric J. Chow
- Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
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4
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Li L, Zhang D, Li Y, Jain M, Lin X, Hu R, Liu J, Thapa J, Mu L, Chen Z, Liu B, Pagán JA. Medical financial hardship between young adult cancer survivors and matched individuals without cancer in the United States. JNCI Cancer Spectr 2024; 8:pkae007. [PMID: 38366027 PMCID: PMC10903972 DOI: 10.1093/jncics/pkae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties young adult cancer survivors in the United States experience in the post-Patient Protection and Affordable Care Act period. METHOD We identified 1009 cancer survivors aged 18 to 39 years from the National Health Interview Survey (2015-2022) and matched 963 (95%) cancer survivors to 2733 control individuals using nearest-neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and to assess whether this association varied by age, sex, race and ethnicity, and region of residence. RESULTS Compared with those who did not have a history of cancer, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio = 1.65, 95% confidence interval = 1.50 to 1.81) and behavior-related financial hardship (34.3% vs 24.4%; odds ratio = 1.62, 95% confidence interval = 1.49 to 1.76) but not psychological financial hardship (52.6% vs 50.9%; odds ratio = 1.07, 95% confidence interval = 0.99 to 1.16). Young adult cancer survivors who were Hispanic or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts. CONCLUSIONS We found that young adult cancer survivors were more likely to experience material and behavior-related financial hardship than young adults without a history of cancer. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.
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Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mayuri Jain
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xingyu Lin
- Department of Statistical and Actuarial Sciences, University of Western Ontario, London, ON, Canada
| | - Rebecca Hu
- Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janani Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Lan Mu
- Department of Geography, University of Georgia, Athens, GA, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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Štrublová L, Kepák T, Kuruczová D, Zlámal F, Holíková M, Kepáková K, Štěrba J, Bienertová-Vašků J. Socioeconomic status and adiposity in childhood cancer survivors: A cross-sectional retrospective study. PLoS One 2024; 19:e0298068. [PMID: 38363727 PMCID: PMC10871493 DOI: 10.1371/journal.pone.0298068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024] Open
Abstract
This is a retrospective cross-sectional study examining the association between unemployment, cancer type, treatment and total body fat percentage of childhood cancer survivors recruited at St. Anne's University Hospital in Brno, Czech Republic. A total of 55 survivors aged 18-49 who were in remission of cancer and fulfilled the criteria for body composition measurements by the BIA and completed questionnaires investigating their socioeconomic status, employment status, and history. There was a significant relationship between the employment status and central nervous system-directed treatment (c2(1) = 7.53, p = 0.006, Cramér's V = 0.38) and between the type of cancer and employment status (c2(3) = 7.83, p = 0.049, Cramér's V = 0.38), the highest unemployment rate was recorded for brain and spine survivors (72.7%) compared to survivors with other diagnosis (35.7%) (uLR(1) = 4.91, p = 0.027; OR = 4.80, 95% CI:1.10-20.86, p = 0.036); these survivors did not have a significantly different body fat percentage compared to survivors with other diagnoses (t(53) = 1.29, p = 0.202, Cohen's d = 0.41) Interestingly, the survivors reporting having a partner also had a significantly higher percentage of body fat (t(53) = 2.90, p = 0.005, Cohen's d = 0.81). A linear regression model was used to model the percentage of body fat in relation to a set of selected variables and the we observed a significant effect of sex (female vs male: b = 6.37, 95% CI: 1.82-10.93, p = 0.007), partnership status (yes vs no: b = 5.65, 95% CI: 0.67-10.62, p = 0.027) and category of diagnosis (Brain and spinal column tumors vs Other solid tumors: b = 12.40, 95% CI: 0.59-24.21, p = 0.040; Brain and spinal column tumors vs Lymphoma: b = 14.02, 95% CI: 2.06-25.97, p = 0.023). Employment status and risk of adiposity in childhood cancer survivors depends on the type of treatment and diagnosis group, which may significantly impact their lifestyle and overall quality of life after treatment. Trial registration: This study was registered on July 29, 2022, at ClinicalTrials.gov (NCT05481229).
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Affiliation(s)
- Lucie Štrublová
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Kepák
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Daniela Kuruczová
- Department of Food Technology, Mendel University, Brno, Czech Republic
| | - Filip Zlámal
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Marta Holíková
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Kateřina Kepáková
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Jaroslav Štěrba
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
- Department of Paediatric Oncology, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Julie Bienertová-Vašků
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
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Kyrönlahti A, Erdmann F, Feychting M, Frederiksen LE, Hirvonen E, Korhonen LM, Krøyer A, Mader L, Malila N, Mogensen H, Pedersen C, Talbäck M, Taskinen M, Winther JF, Madanat‐Harjuoja L, Pitkäniemi J. Income disparities between adult childhood cancer survivors and their peers-A register-based cohort study from the SALiCCS research programme. Cancer Med 2023; 12:16455-16468. [PMID: 37305982 PMCID: PMC10469706 DOI: 10.1002/cam4.6218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Childhood cancer survivors face various adverse consequences. This Nordic register-based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. METHODS We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age-, sex-, and country-matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990-2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. RESULTS The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16-1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to transition from low to middle/high income and 12% (10%-15%) more likely to transition from middle/high to low income during follow-up. Among those initially in the low income category, survivors were 7% (95% CI 3%-11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to remain in the middle/high income and 45% (37%-53%) more likely to transition to the low income category permanently. CONCLUSIONS Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.
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Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Division of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University MainzGermany
- Department of Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
| | - Maria Feychting
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | | | | | - Liisa Maria Korhonen
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anja Krøyer
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Childhood Cancer Research GroupInstitute of Social and Preventive Medicine, University of BernBernSwitzerland
- Cancer Registry Bern‐SolothurnUniversity of BernBernSwitzerland
| | | | - Hanna Mogensen
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Camilla Pedersen
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Mats Talbäck
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Mervi Taskinen
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Division of Pediatric Hematology, Oncology, and Stem Cell TransplantationHelsinki University HospitalHelsinkiFinland
| | | | - Laura Madanat‐Harjuoja
- Finnish Cancer RegistryHelsinkiFinland
- Dana Farber/Boston Children's Cancer and Blood Disorders ClinicBostonMassachusettsUSA
| | - Janne Pitkäniemi
- Finnish Cancer RegistryHelsinkiFinland
- Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
- Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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7
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Barbati M, Kicinski M, Suciu S, Mazingue F, Vandecruys E, Plat G, Uyttebroeck A, Paillard C, Dresse M, Simon P, Pluchart C, Minckes O, Ferster A, Freycon C, Millot F, Van Der Werff ten Bosch J, Chantrain C, Paulus R, de Schaetzen G, Rossi G, Rohrlich P, Benoit Y, Piette C. Socio-economic outcomes among long-term childhood acute lymphoblastic leukaemia survivors enrolled between 1971 and 1998 in EORTC CLG studies: Results of the 58LAE study. Eur J Cancer Care (Engl) 2022; 31:e13755. [PMID: 36284405 PMCID: PMC9787328 DOI: 10.1111/ecc.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the socio-economic outcomes of survivors of childhood acute lymphoblastic leukaemia (ALL). METHODS Childhood ALL adult survivors, enrolled in EORTC trials between 1971 and 1998 in France and Belgium, were invited to fill out a questionnaire with information about their socio-economic situation (living with a partner, having a university degree, having a job, working part time and history of having a paid job). The outcomes were compared with two matched control populations. RESULTS Among 1418 eligible patients, 507 (35.8%) participated, including 39 (8%) and 61 (12%) patients who received a haematopoietic stem cell transplantation (HSCT) and a cranial radiotherapy (CRT), respectively. The median time to follow-up was 20 years, and median age was 25 years. Survivors showed a socio-economic level at least as good as controls. HCST and CRT were associated with a higher probability of not obtaining a bachelor degree (respectively OR = 3.49, 95% CI: 1.46-8.35 and OR = 2.31, 95% CI: 1.04-5.15), HSCT was associated with unemployment (OR = 2.89, 95% CI: 1.09-7.65) and having a relapse was associated with a higher probability of not having a partner (OR = 1.88, 95% CI: 1.01-3.51) adjusting for confounders. CONCLUSION Childhood ALL survivors showed a high level of socio-economic participation. HCST and CRT were associated with poorer functioning.
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Affiliation(s)
- Melissa Barbati
- Department of Pediatric Hematology‐OncologyCHRU LilleLilleFrance
| | | | - Stefan Suciu
- Statistics DepartmentEORTC HeadquartersBrusselsBelgium
| | | | - Els Vandecruys
- Department of Pediatric Hematology‐OncologyGhent University HospitalGhentBelgium
| | | | - Anne Uyttebroeck
- Department of Pediatric Hemato‐OncologyUniversity Hospital LeuvenLeuvenBelgium
| | - Catherine Paillard
- Department of Pediatric Hematology‐OncologyCHRU StrasbourgStrasbourgFrance
| | | | | | - Claire Pluchart
- Department of Pediatric Haematology and OncologyCHU ReimsReimsFrance
| | - Odile Minckes
- Department of Pediatric Hematology‐OncologyCHU CaenCaenFrance
| | - Alina Ferster
- Department of Hemato‐OncologyHUDERF (ULB)BrusselsBelgium
| | - Claire Freycon
- Department of Pediatric Hematology‐OncologyCHU GrenobleGrenobleFrance
| | - Frederic Millot
- Department of Pediatric Hematology‐OncologyCHU PoitiersPoitiersFrance
| | | | | | | | | | - Giovanna Rossi
- Medical DepartmentEORTC HeadquartersBrusselsBelgium,Present address:
R&D DepartmentBreast International Group (BIG)BrusselsBelgium
| | | | - Yves Benoit
- Department of Pediatric Hematology‐OncologyGhent University HospitalGhentBelgium
| | - Caroline Piette
- Department of PaediatricsUniversity Hospital Liège and University of LiègeLiègeBelgium
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Employment among Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14194586. [PMID: 36230516 PMCID: PMC9559689 DOI: 10.3390/cancers14194586] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
To date, there are heterogeneous studies related to childhood cancer survivors’ (CCS) employment rates. Given the importance of this topic, we aimed to perform a systematic review and meta-analysis to investigate the prevalence of employment among CCS and to examine its association with socio-demographic and clinical factors. We followed the PRISMA guidelines to search for pertinent articles in relevant electronic databases. Eighty-nine articles comprising 93 cohorts were included. The overall prevalence of employment was 66% (CI: 95% 0.63–0.69). Subgroup meta-analyses showed that lower rates were found for central nervous system tumor survivors (51%, CI: 95% 0.43–0.59), and for CCS treated with cranial-radiotherapy (53%, CI: 95% 0.42–0.64) or haematopoietic stem-cell transplantation (56%, CI: 95% 0.46–0.65). The studies conducted in Asia highlighted employment rates of 47% (CI: 95%, 0.34–0.60). Univariate meta-regressions identified the following socio-demographic factors associated with higher rates of employment: a female gender (p = 0.046), a higher mean age at the time of investigation (p = 0.00), a longer time since diagnosis (p = 0.00), a higher educational level (p = 0.03), and a married status (p = 0.00). In conclusion, this systematic review and meta-analysis provides evidence that two-thirds of CCS are employed worldwide. Identifying vulnerable groups of CCS may allow for the design of multidisciplinary support strategies and interventions to promote employment in this population.
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9
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Zhao X, Tong S, Yang Y. The Correlation Between Quality of Life and Positive Psychological Resources in Cancer Patients: A Meta-Analysis. Front Psychol 2022; 13:883157. [PMID: 35783766 PMCID: PMC9245894 DOI: 10.3389/fpsyg.2022.883157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/12/2022] [Indexed: 01/30/2023] Open
Abstract
Purpose This study aimed to assess the evidence of the association between positive psychological resources and quality of life in patients with cancer. Methods Electronic searching was performed to retrieve articles from PubMed, Web of Science, Embase, CNKI, and CBM (from inception to 7 April 2022). Summary correlation coefficient (r) values were extracted from each study, and 95% CIs were calculated by the random-effect model. Subgroup and sensitivity analyses were performed to investigate potential heterogeneity. Results In total, sixty-six articles were included in the present study. The pooled r for resilience was 0.71 (95%CI: 0.55, 0.87), hope 0.50 (95%CI: 0.43, 0.56), self-efficacy 0.53 (95%CI: 0.46, 0.61), self-esteem 0.46 (95%CI: 0.28, 0.63), and optimism 0.30 (95%CI: 0.19, 0.40). For subgroup analysis, no significant differences were found between minors and adults. Conclusion This study indicated that resilience, hope, optimism, self-esteem, and self-efficacy were positively correlated with quality of life in patients with cancers. Therefore, intervention programs should be focused on increasing state-like positive psychological resources to improve the quality of life in patients with cancer.
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Affiliation(s)
- Xinxin Zhao
- Department of Hospice, ShengJing Hospital of China Medical University, Shenyang, China
| | - Siqi Tong
- Lymphedema Therapeutic Center, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Ye Yang
- Department of Ultrasound, ShengJing Hospital of China Medical University, Shenyang, China
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10
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Williams AM, Mirzaei Salehabadi S, Xing M, Phillips NS, Ehrhardt MJ, Howell R, Yasui Y, Oeffinger KC, Gibson T, Chow EJ, Leisenring W, Srivastava D, Hudson MM, Robison LL, Armstrong GT, Krull KR. Modifiable risk factors for neurocognitive and psychosocial problems after Hodgkin lymphoma. Blood 2022; 139:3073-3086. [PMID: 34861035 PMCID: PMC9121843 DOI: 10.1182/blood.2021013167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Long-term survivors of childhood Hodgkin lymphoma (HL) experience a high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. A total of 1760 survivors of HL (mean ± SD age, 37.5 ± 6.0 years; time since diagnosis, 23.6 ± 4.7 years; 52.1% female) and 3180 siblings (mean age, 33.2 ± 8.5 years; 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.3 (1 = mild, 2 = moderate, 3 = severe/disabling, and 4 = life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment, and grade 2 or higher chronic health conditions. Compared with siblings, survivors had significantly higher risk (all, P < .05) of neurocognitive impairment (eg, memory, 8.1% vs 5.7%), anxiety (7.0% vs 5.4%), depression (9.1% vs 7%), unemployment (9.6% vs 4.4%), and impaired physical/mental quality of life (eg, physical function, 11.2% vs 3.0%). Smoking was associated with a higher risk of impairment in task efficiency (RR, 1.56; 95% confidence interval [CI], 1.02-2.39), emotional regulation (RR, 1.84; 95% CI, 1.35-2.49), anxiety (RR, 2.43; 95% CI, 1.51-3.93), and depression (RR, 2.73; 95% CI, 1.85-4.04). Meeting the exercise guidelines of the Centers for Disease Control and Prevention was associated with a lower risk of impairment in task efficiency (RR, 0.70; 95% CI, 0.52-0.95), organization (RR, 0.60; 95% CI, 0.45-0.80), depression (RR, 0.66; 95% CI, 0.48-0.92), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.
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Affiliation(s)
| | | | | | | | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rebecca Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kevin C Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC
| | - Todd Gibson
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, Rockville, MD
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | - Wendy Leisenring
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | | | - Melissa M Hudson
- Department of Epidemiology and Cancer Control
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Kevin R Krull
- Department of Epidemiology and Cancer Control
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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11
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Gupta S, Sutradhar R, Alexander S, Science M, Lau C, Nagamuthu C, Agha M, Nathan PC, Hodgson D. Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Adult Cancer: A Population-Based Study in Ontario, Canada. J Clin Oncol 2022; 40:1281-1290. [PMID: 35226549 DOI: 10.1200/jco.21.02592] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Survivors of childhood, adolescent, and young adult cancer are at risk of late effects, including pulmonary and infectious complications. Whether survivors are at increased risk of COVID-19 infection and severe complications is unknown. METHODS Population-based registries in Ontario, Canada, identified all 5-year survivors of childhood cancer diagnosed age 0-17 years between 1985 and 2014, and of six common adolescent and young adult cancers diagnosed age 15-21 years between 1992 and 2012. Each survivor alive on January 1, 2020, was randomly matched by birth year, sex, and residence to 10 cancer-free population controls. Individuals were linked to population-based laboratory and health care databases to identify COVID-19 tests, vaccinations, infections, and severe outcomes (emergency department [ED] visits, hospitalizations, intensive care unit admissions, and death within 60 days). Demographic, disease, and treatment-related variables were examined as possible predictors of outcomes. RESULTS Twelve thousand four hundred ten survivors were matched to 124,100 controls. Survivors were not at increased risk of receiving a positive COVID-19 test (386 [3.1%] v 3,946 [3.2%]; P = .68) and were more likely to be fully vaccinated (hazard ratio, 1.23; 95 CI, 1.20 to 1.37). No increase in risk among survivors was seen in emergency department visits (adjusted odds ratio, 1.2; 95 CI, 0.9 to 1.6; P = .19) or hospitalization (adjusted odds ratio, 1.8; 95 CI, 1.0 to 3.5; P = .07). No survivor experienced intensive care unit admission or died after COVID-19 infection. Pulmonary radiation or chemotherapies associated with pulmonary toxicity were not associated with increased risk. CONCLUSION Cancer survivors were not at increased risk of COVID-19 infections or severe sequelae. These results can inform risk-counseling of survivors and their caregivers. Further study is warranted to determine risk in older survivors, specific subsets of survivors, and that associated with novel COVID-19 variants.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
| | - Rinku Sutradhar
- Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
| | - Sarah Alexander
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Michelle Science
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Cindy Lau
- Cancer Research Program, ICES, Toronto, Canada
| | | | - Mohammad Agha
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Pediatric Oncology Group of Ontario, Toronto, Canada.,Primary Care & Health Systems Research Program, ICES, Toronto, Canada
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Research Program, ICES, Toronto, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Canada
| | - David Hodgson
- Pediatric Oncology Group of Ontario, Toronto, Canada.,Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
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12
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Devine KA, Christen S, Mulder RL, Brown MC, Ingerski LM, Mader L, Potter EJ, Sleurs C, Viola AS, Waern S, Constine LS, Hudson MM, Kremer LCM, Skinner R, Michel G, Gilleland Marchak J, Schulte FSM. Recommendations for the surveillance of education and employment outcomes in survivors of childhood, adolescent, and young adult cancer: A report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Cancer 2022; 128:2405-2419. [PMID: 35435238 PMCID: PMC9321726 DOI: 10.1002/cncr.34215] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
Educational achievement and employment outcomes are critical indicators of quality of life in survivors of childhood, adolescent, and young adult (CAYA) cancer. This review is aimed at providing an evidence-based clinical practice guideline (CPG) with internationally harmonized recommendations for the surveillance of education and employment outcomes in survivors of CAYA cancer diagnosed before the age of 30 years. The CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating concordances and discordances of 4 existing CPGs, the authors performed a systematic literature search through February 2021. They screened articles for eligibility, assessed quality, and extracted and summarized the data from included articles. The authors formulated recommendations based on the evidence and clinical judgment. There were 3930 articles identified, and 83 of them, originating from 17 countries, were included. On a group level, survivors were more likely to have lower educational achievement and more likely to be unemployed than comparisons. Key risk factors for poor outcomes included receiving a primary diagnosis of a central nervous system tumor and experiencing late effects. The authors recommend that health care providers be aware of the risk of educational and employment problems, implement regular surveillance, and refer survivors to specialists if problems are identified. In conclusion, this review presents a harmonized CPG that aims to facilitate evidence-based care, positively influence education and employment outcomes, and ultimately minimize the burden of disease and treatment-related late adverse effects for survivors of CAYA cancers. LAY SUMMARY: A multidisciplinary panel has developed guidelines for the surveillance of education and employment outcomes among survivors of childhood, adolescent, and young adult cancer. On the basis of evidence showing that survivors are at risk for lower educational achievement and unemployment, it is recommended that all survivors receive regular screening for educational and employment outcomes.
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Affiliation(s)
- Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Salome Christen
- Health Science and Health Policy, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Morven C Brown
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.,Newcastle University Centre for Cancer, Newcastle Upon Tyne, United Kingdom
| | - Lisa M Ingerski
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Luzius Mader
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Adrienne S Viola
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | | | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.,Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Roderick Skinner
- Newcastle University Centre for Cancer, Newcastle Upon Tyne, United Kingdom.,Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Gisela Michel
- Health Science and Health Policy, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Fiona S M Schulte
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Hong HC, Min A, Kim YM. A systematic review and pooled prevalence of symptoms among childhood and adolescent and young adult cancer survivors. J Clin Nurs 2022; 32:1768-1794. [PMID: 35014094 DOI: 10.1111/jocn.16201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/24/2021] [Accepted: 12/20/2021] [Indexed: 01/15/2023]
Abstract
AIMS AND OBJECTIVES To systematically review the existing literature reporting symptoms in childhood and adolescent and young adult cancer survivors and to meta-analyse the pooled prevalence of symptoms. BACKGROUND Cancer survivors experience various symptoms caused by cancer treatments and their late effects. These symptoms are associated with adverse health outcomes. However, estimates of symptom prevalence vary largely, and no comprehensive review of symptoms has been conducted for childhood and adolescent and young adult cancer survivors. DESIGN A systematic review. METHODS This systematic review is registered in PROSPERO registry and was performed following the PRISMA guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL were searched up to July 2021. Three investigators assessed the eligibility of studies, extracted data and performed quality assessment. The pooled prevalence of symptoms was calculated using a random-effect model. Subgroup analysis was conducted to identify heterogeneity. RESULTS Sixty-one studies were used to synthesise symptom prevalence, involving 114,184 participants. There were 24 physical symptoms and 10 psychological symptoms reported in two or more studies. The most studied physical symptoms were fatigue and sleep disturbance, and the most studied psychological symptoms were anxiety and depression. Among physical symptoms, drowsiness had the highest prevalence, followed by dry mouth and fatigue. Among psychological symptoms, worry and nervousness had the highest prevalence, followed by difficulty concentrating. CONCLUSIONS Physical and psychological symptoms are common in the target population. This review provides an up-to-date overview of symptom prevalence, identifying areas for future research. RELEVANCE TO CLINICAL PRACTICE Education about possible symptoms related to cancer and its treatment should be given while in treatment. Symptoms should also be monitored throughout the survivorship period. Nurses have a critical role in identifying and making referrals for psychological symptoms as well as promoting preventative strategies that enhance well-being.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Young Man Kim
- College of Nursing ∙ Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Korea
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14
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Frederiksen LE, Pedersen C, Mogensen H, Mader L, Bautz A, Talbäck M, Hirvonen E, Norsker FN, Hasle H, Malila N, Madanat-Harjuoja L, Feychting M, Erdmann F, Winther JF. Employment status and occupational positions of childhood cancer survivors from Denmark, Finland and Sweden: A Nordic register-based cohort study from the SALiCCS research programme. THE LANCET REGIONAL HEALTH. EUROPE 2021; 12:100258. [PMID: 34901911 PMCID: PMC8640515 DOI: 10.1016/j.lanepe.2021.100258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A childhood cancer diagnosis and late effects of treatment may affect survivors' possibilities of employment or highly skilled occupations later in life. In this study, we compared the employment and occupational status of childhood cancer survivors with population comparisons and siblings. METHODS In a cohort study based on Nordic registers, we identified 10 461 survivors of childhood cancer diagnosed before age 20 years in Denmark, Finland and Sweden since 1971. Survivors were compared with 48 928 population comparisons matched to survivors by age, sex and geographical region and 12 605 siblings of survivors. Annual outcome information on employment, unemployment, health-related unemployment and occupational position was obtained from the statistical institutes between 1980-2017 and assessed in multivariate logistic regression analyses from age 30 onwards. FINDINGS By 30 years of age, 9.2% (95% CI, 8.6-9.9%) of survivors were unemployed for health reasons. Childhood cancer survivors had considerably higher odds of health-related unemployment at ages 30, 40 and 50 than population comparisons (ORage30, 2.57; 95% CI, 2.35-2.81) and siblings (ORage30, 2.50; 95% CI, 2.15-2.90). We observed no large difference in unemployment unrelated to health or in occupational position. Health-related unemployment was particularly pronounced among survivors of central nervous system tumours and survivors diagnosed below 15 years of age. INTERPRETATION Survivors at risk of health-related unemployment should be offered comprehensive survivorship care and interventions for obtaining and maintaining suitable employment. FUNDING NordForsk [76111], the Danish Childhood Cancer Foundation [2016-0293], Aarhus University [43239402], the Swedish Childhood Cancer Foundation [PR2020-0130] and [OB2019-0003], Tømrermester Jørgen Holm og Hustru Elisa F. Hansens Mindelegat [20088] and the Swiss National Science Foundation to LM [P2LUP3_175288].
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Affiliation(s)
- Line Elmerdahl Frederiksen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Corresponding author: Line Elmerdahl Frederiksen, PhD, Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen.
| | - Camilla Pedersen
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Andrea Bautz
- The Danish Clinical Quality Program – National Clinical Registries, Frederiksberg, Denmark
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland,Dana Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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15
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[Consequences of childhood cancer in the quest for first job in the Grand Ouest inter-region: A mixed-method study designed from the Grand Ouest Cancer de l'Enfant (GOCE) organization in childhood cancer survivors and professionals]. Bull Cancer 2021; 109:318-330. [PMID: 34656299 DOI: 10.1016/j.bulcan.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The professional situation of patients treated for childhood cancer differs from country to country. The aim of the study is to study, with the French sociocultural specificities, the first professional integration of these young people. METHODS A sequential quantitative-qualitative mixed approach associates 16 individual interviews and responses to a self-questionnaire of 254 young cancer survivors (sex-ratio=1, median age 23.5 years diagnosed between 2000 and 2010; 68% leukemia) to 30 individual and collective interviews of professionals. Results They seem to have had fewer difficulties than the general population to find their first job (33% vs. 44%). Young women had more difficulties, young people thought they had stopped studying too early and those who mentioned their sequelae (mainly psychological and neurocognitive). The qualitative phase shows that, in this context, the information provided during the job interview plays an important role in access to the first job. DISCUSSION The study showed a need for information, communication and training for all actors whose main axes could be: i) for young people: learn to introduce themselves and adapt speeches and postures, be aware of their non-obligation to reveal a situation relating to health and to the handicap; ii) for the medical profession: to promote communication and to find spaces for exchanges between specialists, generalists, occupational physicians; iii) for employers: better know the disease and the laws to adapt their eyes and practices.
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16
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Sato S, Li N, Dixon SB, Kato M, Zhang H, Li CK, Howell RM, Leisenring WM, Bhatia S, Oeffinger KC, Armstrong GT, Yasui Y, Krull KR, Cheung YT. Functional Outcomes and Social Attainment in Asian/Pacific Islander Childhood Cancer Survivors in the United States: A Report from the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2244-2255. [PMID: 34607839 DOI: 10.1158/1055-9965.epi-21-0628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 09/23/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Given the relatively small population of Asians or Pacific Islanders (API) in the United States, studies describing long-term outcomes in API survivors of childhood cancer are limited. This study compared functional outcomes between API versus non-Hispanic White (NHW) survivors. METHODS This study included 203 API 5-year survivors [age at follow-up: 29.2 (SD = 6.3) years] and 12,186 NHW survivors [age at follow-up 31.5 (SD = 7.3) years] from the Childhood Cancer Survivor Study. Self-reported functional outcomes of neurocognitive function, emotional distress, quality of life, and social attainment were compared between the two groups using multivariable regression, adjusted for sex, age at diagnosis and evaluation, cancer diagnosis, and neurotoxic treatment. RESULTS No statistically significant race/ethnicity-based differences were identified in neurocognitive and emotional measures. API survivors reported, on average, less bodily pain than NHW survivors [mean 54.11 (SD = 8.98) vs. 51.32 (SD = 10.12); P < 0.001]. NHW survivors were less likely to have attained at least a college degree than API survivors [OR = 0.50; 95% confidence interval (CI) = 0.34-0.73]. API survivors were more likely than NHW survivors to be never-married (OR = 2.83; 95% CI = 1.93-4.13) and to live dependently (OR = 3.10; 95% CI = 2.02-4.74). Older age (>45 years), brain tumor diagnosis, and higher cranial radiation dose were associated with poorer functional outcomes in API survivors (all, P < 0.05). CONCLUSIONS We observed differences in social attainment between API and NHW survivors, although statistically significant differences in neurocognitive and emotional outcomes were not identified. IMPACT Future studies should evaluate whether racial/ethnic differences in environmental and sociocultural factors may have differential effects on health and functional outcomes.
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Affiliation(s)
- Satomi Sato
- Division of Health and Behavioral Sciences, St. Luke's International University, Tokyo, Japan
| | - Nan Li
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephanie B Dixon
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Miho Kato
- Department of Children's Cancer Data Management, National Center for Child Health and Development, Tokyo, Japan
| | - Hui Zhang
- Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai, P.R. China.,Department of Hematology & Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, P.R. China
| | - Chi Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Rebecca M Howell
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Smita Bhatia
- School of Medicine Institute for Cancer Outcomes and Survivorship, University of Alabama Birmingham, Birmingham, Alabama
| | | | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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17
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Fair D, Park ER, Nipp RD, Rabin J, Hyland K, Kuhlthau K, Perez GK, Nathan PC, Armstrong GT, Oeffinger KC, Robison LL, Leisenring W, Kirchhoff AC. Material, behavioral, and psychological financial hardship among survivors of childhood cancer in the Childhood Cancer Survivor Study. Cancer 2021; 127:3214-3222. [PMID: 34061973 PMCID: PMC8489494 DOI: 10.1002/cncr.33613] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/03/2021] [Accepted: 03/28/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Medical financial burden includes material, behavioral, and psychological hardship and has been underinvestigated among adult survivors of childhood cancer. METHODS A survey from 698 survivors and 210 siblings from the Childhood Cancer Survivor Study was analyzed. The intensity of financial hardship was estimated across 3 domains: 1) material, including conditions that arise from medical expenses; 2) behavioral, including coping behaviors to manage medical expenses; and 3) psychological hardship resulting from worries about medical expenses and insurance, as measured by the number of instances of each type of financial hardship (0, 1-2, and ≥3 instances). Multivariable logistic regressions were conducted to examine the clinical and sociodemographic predictors of experiencing financial hardship (0-2 vs ≥3 instances). RESULTS The intensity of financial hardship did not significantly differ between survivors and siblings. Survivors reported more instances of material hardship than siblings (1-2 instances: 27.2% of survivors vs 22.6% of siblings; ≥3 instances: 15.9% of survivors vs 11.4% siblings; overall P = .03). In multivariable regressions, insurance was protective against all domains of financial hardship (behavioral odds ratio [OR], 0.12; 95% confidence interval [CI], 0.06-0.22; material OR, 0.37; 95% CI, 0.19-0.71; psychological OR, 0.10; 95% CI, 0.05-0.21). Survivors who were older at diagnosis, female, and with chronic health conditions generally had higher levels of hardship. Brain radiation and alkylating agents were associated with higher levels of hardship. CONCLUSIONS Material, behavioral, and psychological financial burden among survivors of childhood cancer is common.
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Affiliation(s)
- Douglas Fair
- University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
| | - Elyse R Park
- Massachusetts General Hospital, Boston, Massachusetts
| | - Ryan D Nipp
- Massachusetts General Hospital, Boston, Massachusetts
| | - Julia Rabin
- Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly Hyland
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Paul C Nathan
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Anne C Kirchhoff
- University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, Salt Lake City, Utah
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18
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Hong HC, Min A, Choi S. Living with the Late Effects of Childhood Cancer Treatment: A Descriptive Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8392. [PMID: 34444141 PMCID: PMC8393717 DOI: 10.3390/ijerph18168392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
Long-term childhood cancer survivors (CCS) may experience physical, social, and emotional struggles posttreatment. Our aim was to explore the experiences of CCS dealing with the late effects of cancer treatment from their own perspectives. This study employed a qualitative descriptive design to explore and describe the experience of dealing with late effects among CCS. Semi-structured interviews were conducted with 15 CCS in Korea. Participants were selected by purposive and snowball sampling and individually interviewed during the period from September to November 2020. Conventional content analysis was used to analyze data and identify themes. Two main themes and seven subthemes emerged. The two main themes were: "Things I encountered while crossing a bridge" and "Living as a survivor". The participants reported both positive and negative experiences with dealing with the late effects of cancer treatment. The main themes indicated that late effects exert significant impacts on the lives of CCS in both positive and negative ways. Healthcare providers and researchers should pay attention to early intervention needs of CCS and their support systems to strengthen their positive experiences in dealing with late effects during their survivorships.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea; (H.C.H.); (A.M.)
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea; (H.C.H.); (A.M.)
| | - Sungkyoung Choi
- Department of Nursing, Gwangju University, Gwangju 61743, Korea
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19
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Hong HC, Kim YM, Min A. Factors influencing quality of life among childhood cancer survivors in Korea: A quantile regression approach. Res Nurs Health 2021; 45:108-122. [PMID: 34322889 DOI: 10.1002/nur.22170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/13/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022]
Abstract
Cancer treatment in childhood may negatively affect survivors' quality of life. In this study, we aimed to determine the contributing factors for health-related quality of life (HRQOL) in survivors of childhood cancer in Korea using quantile regression analysis. This study was a secondary analysis. Data were collected from 130 childhood cancer survivors (CCS) from November 2018 to July 2019. Participants completed the Memorial Symptom Assessment Scale, Depression Anxiety Stress Scale, Health-Promoting Lifestyle Profile-II, and 36-Item Short Form Health Survey (physical component summary [PCS] and mental component summary [MCS]). Quantile and multiple linear regressions were used to analyze the factors contributing to HRQOL. The quantile and linear regression models revealed different results on the contributing factors to HRQOL in CCS. Mean PCS and MCS scores were 78.55 (SD = 15.08) and 64.02 (SD = 18.00), respectively. Symptoms (e.g., difficulty concentrating, worrying, pain, and lack of energy), physical activity, spiritual growth, interpersonal relationships, stress management, depression, and anxiety were significant influencing factors in some PCS quantiles, while symptoms, spiritual growth, interpersonal relationships, depression, and stress were significant influencing factors in some MCS quantiles. The findings of this study showed specific contributing factors in CCS with different levels of HRQOL. There is a need for targeted interventions related to risk reduction and stratification for CCS with different HRQOL levels. Symptom management strategies, early detection programs for CCS with psychological distress, and clinical and counseling interventions for CCS with poor HRQOL need to be developed.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Young Man Kim
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Jeollabuk-do, South Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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20
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Yeung NCY, Cheung KC, Chau HC, Leung AWK, Li CK, Lam TTN, Cheng HY, Cheung YT. Transition from Acute Treatment to Survivorship: Exploring the Psychosocial Adjustments of Chinese Parents of Children with Cancer or Hematological Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157815. [PMID: 34360108 PMCID: PMC8345777 DOI: 10.3390/ijerph18157815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023]
Abstract
Objectives: Parents of children diagnosed with critical illnesses face multiple challenges during their caregiving experience. However, relevant studies have been limited in the Chinese context. Guided by the stress and coping model, we conducted a qualitative study to identify the stressors, coping strategies, and adjustment experiences of Hong Kong parents of children with cancer or hematological disorders. Methods: We recruited 15 parents of children with cancer or hematological disorders requiring bone marrow transplantation and were currently >2 years post-treatment. They participated in a 30-min semi-structured interview. Thematic analysis was performed using the grounded theory approach. Results: The stressors reported by parents included a high caregiving burden during their children’s diagnosis and treatment stages. The fear of recurrence, the need for information, and concerns about late effects were also common among the parents during their children’s transition/survivorship stage. To cope with these stressors, the parents commonly used problem-focused (e.g., seeking help from professionals and support groups) and emotion-focused (e.g., behavioral distractions, venting, and crying) strategies. Despite these stressors, parents reported positive changes through the caregiving experience, such as improved family relationships, developing health-protective habits, and the reprioritization of different aspects of life. Conclusions: Parents encounter different stressors during the cancer care continuum. Using different coping strategies, parents experience positive changes amidst caregiving. Future studies should explore culturally relevant adaptive coping strategies to enhance parents’ psychosocial adjustment.
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Affiliation(s)
- Nelson Chun Yiu Yeung
- Faculty of Medicine, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Correspondence: (N.C.Y.Y.); (Y.T.C.)
| | - Ka Chun Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
| | - Ho Cheung Chau
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
| | - Alex Wing Kwan Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong; (A.W.K.L.); (C.K.L.)
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chi Kong Li
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong; (A.W.K.L.); (C.K.L.)
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - Teddy Tai Ning Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
- Little Life Warriors Society Hong Kong, Hong Kong
| | - Ho Yu Cheng
- Faculty of Medicine, Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong;
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; (K.C.C.); (H.C.C.); (T.T.N.L.)
- Correspondence: (N.C.Y.Y.); (Y.T.C.)
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21
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Lu AD, Zheng Z, Han X, Qi R, Zhao J, Yabroff KR, Nathan PC. Medical Financial Hardship in Survivors of Adolescent and Young Adult Cancer in the United States. J Natl Cancer Inst 2021; 113:997-1004. [PMID: 33839786 DOI: 10.1093/jnci/djab013] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States. METHODS We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately. RESULTS A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior. CONCLUSIONS Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes.
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Affiliation(s)
- Amy D Lu
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Zhiyuan Zheng
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Ruowen Qi
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Paul C Nathan
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
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22
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Woodford J, Månberg J, Cajander Å, Enebrink P, Harila-Saari A, Hagström J, Karlsson M, Placid Solimena H, von Essen L. Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden. BMJ Open 2021; 11:e041350. [PMID: 34155002 PMCID: PMC8039225 DOI: 10.1136/bmjopen-2020-041350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support. E-mental health (e-MH) may offer a solution to reduce this treatment gap. However, research examining e-MH for AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to: (1) help-seeking behaviour and/or (2) e-MH acceptability. The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen's behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MH interventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking. METHODS AND ANALYSIS An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16-39 years, diagnosed with cancer when 0-18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-06271). Results will be disseminated in scientific publications and academic conference presentations. TRIAL REGISTRATION NUMBER ISRCTN70570236.
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Affiliation(s)
- Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jenny Månberg
- Child and Adolescent Psychiatry, Region Vasternorrland, Sundsvall, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Arja Harila-Saari
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mathilda Karlsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Placid Solimena
- International Maternal and Child Health Care, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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23
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Hong HC, Kim YM, Min A. Symptom clusters in childhood cancer survivors in Korea: A latent class analysis. Eur J Cancer Care (Engl) 2020; 29:e13322. [DOI: 10.1111/ecc.13322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/24/2020] [Accepted: 08/07/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Hye Chong Hong
- Chung‐Ang University Red Cross College of Nursing Seoul South Korea
| | - Young Man Kim
- College of Nursing, Research Institute of Nursing Science Jeonbuk National University Jeonju‐si Jeollabuk‐do South Korea
| | - Ari Min
- Chung‐Ang University Red Cross College of Nursing Seoul South Korea
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24
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Yang H, Fong S, Chan P, Cheung A, Peng L, Yan J, Cheung YT, Li CK. Life Functioning in Chinese Survivors of Childhood Cancer in Hong Kong. J Adolesc Young Adult Oncol 2020; 10:326-335. [PMID: 32721257 DOI: 10.1089/jayao.2020.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Evidence on self-care ability and occupational outcomes in Chinese survivors of childhood cancer is clearly lacking. This study aims to identify clinical and behavioral factors associated with poor life functioning in this population. Methods: This was a cross-sectional study conducted at an ambulatory clinic of a public hospital in Hong Kong. Licensed occupational therapists administered the Life Functioning Assessment Inventory on survivors diagnosed with cancer <19 years old and ≥5 years post-diagnosis. Survivors' career development self-efficacy, subjective happiness, and motivation were evaluated using structured questionnaires. Clinical information was obtained from medical records. Multivariable linear regression was used to evaluate factors associated with life functioning outcomes, adjusting for clinically relevant variables. Results: Eighty survivors were recruited (58.7% male; age at diagnosis: 6.7 [standard deviation (SD) = 4.8] years; age at evaluation: 24.4 [SD = 6.5] years). Compared to survivors of leukemia, survivors of brain tumor performed worse in social functioning (β = -0.79, standard error [SE] = 0.36; p = 0.034). Survivors who had been treated with cranial radiation also had lower worker life functioning than those who had not (β = -0.91, SE = 0.031; p = 0.021). Higher activity motivation was significantly associated with better leisure functioning (β = 0.086, SE = 0.03; p = 0.008), social functioning (β = 0.036, SE = 0.02; p = 0.036), and career development self-efficacy (β = 1.04, SE = 0.26; p < 0.0001). Conclusion: Survivors of brain tumors and survivors who were treated with radiation have poorer life functioning, particularly in social and work domains. Future work includes validating the study findings in a larger cohort of survivors in Hong Kong. Addressing modifiable behavioral factors include motivating survivors to engage in meaningful activities that contribute to self-care and participation in society, as well as providing at-risk survivors with ongoing support from community vocational services.
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Affiliation(s)
- Hellen Yang
- Occupation Therapy Department, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Sanne Fong
- Occupation Therapy Department, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Phoebe Chan
- Occupation Therapy Department, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Alice Cheung
- Occupational Therapy Department, Princess of Wales Hospital, Hong Kong SAR, China
| | - Liwen Peng
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jiaqi Yan
- School of Public Health, Fudan University, Shanghai, P.R. China
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Kong Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
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25
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Linendoll N, Murphy-Banks R, Barthel E, Bartucca L, Boehm L, Welch M, Weidner RA, Parsons SK. The Creation of a Comprehensive Adolescent and Young Adult Cancer Survivorship Program: "Lost in Transition" No More. J Adolesc Young Adult Oncol 2020; 10:397-403. [PMID: 32640864 DOI: 10.1089/jayao.2020.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The Reid R. Sacco AYA Cancer Program set out to improve survivorship care for AYA-aged patients (15-39 years) of pediatric or AYA cancer. This article discusses the steps in establishing the clinic, including the creation of a database on cancer history, exposures, and attendant risks of late effects. Results from the database tell the broader story of AYAs who seek care within a dedicated survivorship clinic. Methods: The database was created with REDCap® (Research Electronic Data Capture), a secure web-based, HIPAA compliant application for research and clinical study data. Data were abstracted and analyzed by trained members of the program team. Results: A total of 144 patients were seen for their initial survivorship visit between January 2013 and September 2019. Regarding physical health, two-thirds of the patients presented with an established late effect, one third with an established medical comorbidity, and 11% (n = 16) with secondary cancer related to their oncologic treatment. In assessing mental health, a significant cohort reported a known affective disorder (32%, n = 46) with one quarter already taking a psychotropic medication. Despite the transient nature of AYAs, 85% of patients remained in care within the long-term follow-up clinical model. Conclusions: Data presented illustrate how multilayered and complex survivorship care needs can be, as patients enter the clinic with complicated pre-existing psychosocial issues, significant late effects, and comorbidities. This study reinforces the value of a clinical database to better understand AYA survivors with the ultimate goal of optimizing and coordinating care.
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Affiliation(s)
- Nadine Linendoll
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Tufts Medical Center Cancer Center, Boston, Massachusetts, USA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Rachel Murphy-Banks
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Erin Barthel
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lisa Bartucca
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lauren Boehm
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Madison Welch
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ruth Ann Weidner
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Susan K Parsons
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, Massachusetts, USA.,Division of Hematology/Oncology, Tufts Medical Center Cancer Center, Boston, Massachusetts, USA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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26
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Ji X, Cummings JR, Gilleland Marchak J, Han X, Mertens AC. Mental health among nonelderly adult cancer survivors: A national estimate. Cancer 2020; 126:3768-3776. [PMID: 32538481 DOI: 10.1002/cncr.32988] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study assessed mental health (MH) outcomes across age groups in a nationally representative US sample of adult cancer survivors. METHODS The 2015 to 2017 National Survey on Drug Use and Health was used to identify respondents aged 18 to 64 years. The authors compared MH outcomes between respondents with a cancer history and respondents without a cancer history in adjusted analyses controlling for demographics and socioeconomic status. Outcomes included past-year major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. All analyses were stratified by age group (18-34, 35-49, or 50-64 years). RESULTS In a comparison of 2656 survivors and 112,952 individuals without cancer, within each age group, survivors had an elevated prevalence of MH problems in 5 of the 7 outcome measures. Among young adults (aged 18-34 years), survivors were more likely than noncancer counterparts to experience major depressive episodes (18.1% vs 9.6%), serious psychological distress (34.2% vs 17.9%), suicidal thoughts (10.5% vs 7.0%), any mental illness (41.1% vs 23.3%), and serious mental illness (13.2% vs 5.9%) in the past year (P values <.05). These differences persisted in adjusted analyses (P values <.01). Similar survivor-comparison differences were observed among older groups but with a smaller magnitude. Among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all outcomes (P values <.05). CONCLUSIONS This population-based study shows an elevated prevalence of MH problems among adult cancer survivors in comparison with the general population. This finding highlights the importance of developing strategies to ensure the early detection of mental illness and to improve access to MH treatment for cancer survivors.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Janet R Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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27
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What's past is prologue: Recalled parenting styles are associated with childhood cancer survivors' mental health outcomes more than 25 years after diagnosis. Soc Sci Med 2020; 252:112916. [PMID: 32200184 DOI: 10.1016/j.socscimed.2020.112916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/23/2019] [Accepted: 03/08/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND With the increased survival rates of childhood cancer, long-term survivors' well-being over the life span has come into focus. A better understanding of the determinants of childhood cancer survivors' (CCS) mental health outcomes contributes to the identification of vulnerable individuals as well as to the development of evidence-based prevention and intervention efforts. It has been noted that psychosocial factors such as parental rearing behavior shape individual differences in mental health. There is also evidence that parents show altered parenting behavior in the face of childhood cancer, e. g. that they express more emotional support, but also more worries. However, little is known about the relevance of different parenting styles for CCS' mental health decades after diagnosis and treatment. METHODS We examined the associations of recalled parenting styles and disease-related factors with lifetime diagnoses of depression and anxiety disorders in a German, registry-based sample of adult CCS (N = 948, 44.50% women) with survival times >25 years. We conducted logistic regression analyses of lifetime diagnoses of depression and anxiety disorders, respectively, on dimensions of recalled parental rearing behavior (measured with a validated German short version of the EMBU) controlling for relevant adjustment variables such as the presence of physical illnesses. RESULTS Recalled parenting styles of both parents had statistically relevant associations with CCS' lifetime depression and anxiety diagnoses. Maternal emotional warmth was related to fewer lifetime diagnoses of depression and fewer lifetime diagnoses of anxiety. Memories of paternal control and overprotection were positively associated with lifetime diagnoses of anxiety. CONCLUSION The results indicate that mental representations of one's caregivers are associated with psychological long-term outcomes. Thus, medical professionals should involve the parents and support them in accompanying their child through the difficult times of treatment and survivorship. Interventions aimed at fostering survivors' quality of life should consider the sustained relevance of early relationships.
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28
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Ramsey WA, Heidelberg RE, Gilbert AM, Heneghan MB, Badawy SM, Alberts NM. eHealth and mHealth interventions in pediatric cancer: A systematic review of interventions across the cancer continuum. Psychooncology 2019; 29:17-37. [DOI: 10.1002/pon.5280] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Affiliation(s)
- William A. Ramsey
- Department of PsychologySt. Jude Children's Research Hospital Memphis Tennessee
- Department of Counseling Psychology, Education, and ResearchUniversity of Memphis Memphis Tennessee
| | | | - Alexandra M. Gilbert
- Department of PsychologySt. Jude Children's Research Hospital Memphis Tennessee
- Department of PsychologyUniversity of Mississippi Oxford Mississippi
| | - Mallorie B. Heneghan
- Department of PediatricsNorthwestern University Feinberg School of Medicine Chicago Illinois
- Division of Hematology, Oncology and Stem Cell TransplantAnn & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | - Sherif M. Badawy
- Department of PediatricsNorthwestern University Feinberg School of Medicine Chicago Illinois
- Division of Hematology, Oncology and Stem Cell TransplantAnn & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | - Nicole M. Alberts
- Department of PsychologySt. Jude Children's Research Hospital Memphis Tennessee
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29
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Social attainment in survivors of pediatric central nervous system tumors: a systematic review and meta-analysis from the Children's Oncology Group. J Cancer Surviv 2019; 13:921-931. [PMID: 31625086 DOI: 10.1007/s11764-019-00808-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Improved therapies for pediatric central nervous system (CNS) tumors have increased survival rates; however, many survivors experience significant long-term functional limitations. Survivors of pediatric CNS tumors can experience deficits in social attainment. The aim of this review was to systematically amalgamate findings pertaining to social attainment (i.e., educational attainment, marriage, employment outcomes) in survivors of pediatric CNS tumors. METHODS PubMed (web-based), PsycINFO (EBSCO), EMBASE (Ovid), and Web of Science (Thomson Reuters) were used to identify articles published between January 2011 and September 2018. Eligible studies reported outcomes for survivors of pediatric CNS tumors diagnosed before age 21 years and > 5 years from diagnosis and/or > 2 years off therapy. All data were independently abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS The search yielded 7021 unique publications. Forty-six were included in the current review. Meta-analyses revealed survivors of CNS tumors were significantly more likely to have completed compulsory education only (OR = 1.87, 95% CI = 1.66, 2.12, p < 0.00001), less likely to be married (OR = 4.70, 95% CI = 3.89, 5.68, p < 0.00001), and more likely to be unemployed (OR = 2.84, 95% CI = 2.62, 3.08, p < 0.00001) compared to non-cancer controls. Cranial radiation therapy, neurocognitive deficits, and younger age at diagnosis were associated with poorer outcomes. Hearing loss and bilateral blindness were also related to poorer outcomes. Sex did not impact social attainment outcomes. CONCLUSIONS Survivors of pediatric CNS tumors are at elevated risk for poor attainment of key adult social outcomes. IMPLICATIONS FOR CANCER SURVIVORS There is a critical need to develop interventions to support survivors in becoming independent and productive adults.
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Kirchhoff AC, Nipp R, Warner EL, Kuhlthau K, Leisenring WM, Donelan K, Rabin J, Perez GK, Oeffinger KC, Nathan PC, Robison LL, Armstrong GT, Park ER. "Job Lock" Among Long-term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. JAMA Oncol 2019; 4:707-711. [PMID: 29049517 DOI: 10.1001/jamaoncol.2017.3372] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance. Objective To examine the prevalence of "job lock" (staying at a job to keep work-related health insurance) in a sample drawn from an established, multi-institutional cohort of full-time employed childhood cancer survivors compared with a random sample of siblings and to explore factors associated with job lock among cancer survivors. Design, Setting, and Participants Cross-sectional survey of full-time employed adult survivors of childhood cancer and a random sample of siblings derived from a cohort of 25 US pediatric oncology centers. Exposures Data collection included sociodemographic factors, insurance coverage, chronic medical conditions, and treatment. Main Outcomes and Measures Self-report of job lock and factors associated with job lock. Results Among the 522 participants, 394 were cancer survivors (54.5% male) and 128 were siblings (51.5% male). Job lock was reported by 23.2% (95% CI, 18.9%-28.1%) of survivors, compared with 16.9% (95% CI, 11.1%-25.0%) of siblings (P = .16). Job lock was more common among survivors reporting previous health insurance denial (relative risk [RR], 1.60; 95% CI, 1.03-2.52) and problems paying medical bills (RR, 2.43; 95% CI, 1.56-3.80). Among survivors, being female (RR, 1.70; 95% CI, 1.11-2.59; P = .01) and having a severe, disabling, or life-threatening health condition (RR, 1.72; 95% CI, 1.09-2.69; P = .02) were associated with job lock. Conclusions and Relevance Job lock is common among long-term childhood cancer survivors who are employed full-time. A survivor's decision to remain employed at a job in order to maintain health insurance coverage may affect career trajectory, diminish potential earning power, and ultimately impact quality of life.
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Affiliation(s)
- Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City.,Department of Pediatrics, University of Utah, Salt Lake City
| | - Ryan Nipp
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston.,Harvard Medical School, Boston
| | - Echo L Warner
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Karen Kuhlthau
- Department of Pediatrics, Massachusetts General Hospital, Boston.,Department of Pediatrics, Harvard Medical School, Boston
| | - Wendy M Leisenring
- Clinical Research Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karen Donelan
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston
| | - Julia Rabin
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
| | - Giselle K Perez
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
| | - Kevin C Oeffinger
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Elyse R Park
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.,Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
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31
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Howell RM, Smith SA, Weathers RE, Kry SF, Stovall M. Adaptations to a Generalized Radiation Dose Reconstruction Methodology for Use in Epidemiologic Studies: An Update from the MD Anderson Late Effect Group. Radiat Res 2019; 192:169-188. [PMID: 31211642 PMCID: PMC8041091 DOI: 10.1667/rr15201.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Epidemiologic studies that include patients who underwent radiation therapy for the treatment of cancer aim to quantify the relationship between radiotherapy and the risk of subsequent late effects. Because of the long follow-up period required to observe late effects, these studies are conducted retrospectively. The studies routinely include patients treated across numerous institutions using a wide range of technologies and represent treatments over several decades. As a result, determining the dose throughout the patient's body is uniquely challenging. Therefore, estimating doses throughout the patient's body for epidemiologic studies requires special methodologies that are generally applied to a wide range of radiotherapy techniques. Over ten years ago, the MD Anderson Late Effects Group described various dose reconstruction methods for therapeutic and diagnostic radiation exposure for epidemiologic studies. Here we provide an update to the most widely used dose reconstruction methodology for epidemiologic studies, analytical model calculations combined with a 3D age-specific computational phantom. In particular, we describe the various adaptations (and enhancements) of that methodology, as well as how they have been used in radiation epidemiology studies and may be used in future studies.
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Affiliation(s)
- Rebecca M. Howell
- Department of Radiation Physics, The University of Texas at MD Anderson Cancer Center, Houston, Texas
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32
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Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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33
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Ehrhardt MJ, Hochberg J, Bjornard KL, Brinkman TM. Long-term survivors of childhood, adolescent and young adult non-Hodgkin lymphoma. Br J Haematol 2019; 185:1099-1110. [PMID: 30714126 DOI: 10.1111/bjh.15775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Progress in overall survival rates for childhood non-Hodgkin lymphoma (NHL) can be largely attributed to effective development and conduct of a number of international treatment studies. Knowledge gained from these studies has shifted the treatment paradigm from a "one-size fits all" strategy to a histologically dependent approach. More specifically, many now adhere to a risk-stratified approach, prescribing cumulative doses and intensities of chemotherapeutic exposures based upon the aggressiveness of disease. Moreover, recognition that high cure rates could be achieved without the use of radiation has eliminated the use of this modality in frontline settings for the majority of newly diagnosed children. These changes have contributed to the emergence of a heterogeneous group of NHL survivors. As the number of NHL survivors continues to increase, providers will encounter a wide spectrum of individuals whose risk for long-term complications are accordingly diverse. The following review summarizes the existing literature surrounding late effects, such as chronic health conditions, functional and neurocognitive performance outcomes, and health-related quality of life, that are unique to NHL survivors, as well as those extrapolated from the broader childhood cancer survivor population.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica Hochberg
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
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34
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Huang IC, Bhakta N, Brinkman TM, Klosky JL, Krull KR, Srivastava D, Hudson MM, Robison LL. Determinants and Consequences of Financial Hardship Among Adult Survivors of Childhood Cancer: A Report From the St. Jude Lifetime Cohort Study. J Natl Cancer Inst 2019; 111:189-200. [PMID: 30085213 PMCID: PMC6657283 DOI: 10.1093/jnci/djy120] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/23/2018] [Accepted: 06/13/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Financial hardship among survivors of pediatric cancer has been understudied. We investigated determinants and consequences of financial hardship among adult survivors of childhood cancer. METHODS Financial hardship, determinants, and consequences were examined in 2811 long-term survivors (mean age at evaluation = 31.8 years, years postdiagnosis = 23.6) through the baseline survey and clinical evaluation. Financial hardship was measured by material, psychological, and coping/behavioral domains. Outcomes included health and life insurance affordability, retirement planning, symptoms, and health-related quality of life (HRQOL). Odds ratios (ORs) estimated associations of determinants with financial hardship. Odds ratios and regression coefficients estimated associations of hardship with symptom prevalence and HRQOL, respectively. All statistical tests were two-sided. RESULTS Among participants, 22.4% (95% confidence interval [CI] = 20.8% to 24.0%), 51.1% (95% CI = 49.2% to 52.9%), and 33.0% (95% CI = 31.1% to 34.6%) reported material, psychological, and coping/behavioral hardship, respectively. Risk factors across hardship domains included annual household income of $39 999 or less vs $80 000 or more (material OR = 3.04, 95% CI = 2.08 to 4.46, psychological OR = 3.64, 95% CI = 2.76 to 4.80, and coping/behavioral OR = 4.95, 95% CI = 3.57 to 6.86) and below high school attainment vs college graduate or above (material OR = 2.22, 95% CI = 1.45 to 3.42, psychological OR = 1.75, 95% CI = 1.18 to 2.62, and coping/behavioral OR = 2.05, 95% CI = 1.38 to 3.06). Myocardial infarction, peripheral neuropathy, subsequent neoplasm, seizure, stroke, reproductive disorders, amputation, and upper gastrointestinal disease were associated with higher material hardship (all P < .05). Hardship across three domains was associated with somatization, anxiety and depression (all P < .001), suicidal ideation (all P < .05), and difficulty in retirement planning (all P < .001). Survivors with hardship had statistically significantly lower HRQOL (all P < .001), sensation abnormality (all P < .001), and pulmonary (all P < .05) and cardiac (all P < .05) symptoms. CONCLUSIONS A substantial proportion of adult survivors of childhood cancer experienced financial hardship. Vulnerable sociodemographic status and late effects were associated with hardship. Survivors with financial hardship had an increased risk of symptom prevalence and impaired HRQOL.
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Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - DeoKumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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35
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Baker KS, Syrjala KL. Long-term complications in adolescent and young adult leukemia survivors. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:146-153. [PMID: 30504303 PMCID: PMC6245964 DOI: 10.1182/asheducation-2018.1.146] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Adolescents and young adults (AYAs) with cancer, defined by the National Cancer Institute as having been diagnosed between the ages of 15 and 39 years old, have not benefited from the same improvements in quality of outcomes and survival that have been seen for individuals diagnosed in childhood or as older adults. Although is leukemia composed of a diverse group of diagnoses, leukemia AYA survivors share unique vulnerabilities with other AYA diagnostic groups. They will spend the majority of their lives as survivors, with clear evidence of adverse medical conditions, health care requirements, and social and psychological needs that differ not only from their peers but also, from the needs of other cancer survivor populations. Furthermore, they share a developmental stage of life in which careers, finances, and family concerns are uniquely impacted by the cancer diagnosis and treatment. Leukemia in AYAs typically presents with higher-risk biologic features, and treatment requires multiagent chemotherapy, including alkylating agents, anthracyclines, high-dose steroids, frequently intrathecal chemotherapy, and sometimes, cranial radiation. Thus, AYAs have significant risks for long-term complications, subsequent malignancies, and accelerated development of usual age-related comorbid conditions, such as cardiovascular disease and dyslipidemias. AYAs require specialized health care monitoring, surveillance for late effects, and periodic evaluation of psychosocial, health behavior, and life goal outcomes.
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Affiliation(s)
- K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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36
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Frederiksen LE, Mader L, Feychting M, Mogensen H, Madanat-Harjuoja L, Malila N, Tolkkinen A, Hasle H, Winther JF, Erdmann F. Surviving childhood cancer: a systematic review of studies on risk and determinants of adverse socioeconomic outcomes. Int J Cancer 2018; 144:1796-1823. [PMID: 30098012 DOI: 10.1002/ijc.31789] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/20/2018] [Accepted: 07/27/2018] [Indexed: 01/03/2023]
Abstract
Substantial improvements in childhood cancer survival have resulted in a steadily increasing population of childhood cancer survivors. Whereas somatic late effects have been assessed in many studies, less is known about the impact of childhood cancer on socioeconomic outcomes in survivors. The aim of this article was to evaluate and summarise the evidence on the socioeconomic conditions of childhood cancer survivors and to identify survivors at particular risk of adverse socioeconomic outcomes. An extensive literature search of three electronic databases was conducted. Of 419 articles identified, 52 met the inclusion criteria. All the selected articles were appraised for quality, and findings were summarised in a narrative synthesis. Childhood cancer survivors were at higher risk of adverse socioeconomic outcomes with regard to educational achievement, income and social security benefits than the general population or a sibling comparison group. The risks for unemployment and a lower occupational position were significantly increased only for survivors of a central nervous system tumour. Notably, survivors of central nervous system tumours, survivors treated with cranial radiotherapy and those diagnosed at younger age independent of cancer type were determinants of particular adverse socioeconomic outcomes. Given the increasing population of childhood cancer survivors, targeted follow-up interventions and support strategies addressing not only the somatic and psychiatric late effects but also the socioeconomic difficulties that some childhood cancer survivors face is of high importance to reduce social inequity, and ensure a high quality of life after childhood cancer.
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Affiliation(s)
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Anniina Tolkkinen
- Finnish Cancer Registry, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
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37
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Difficulties faced by long-term childhood cancer survivors: A qualitative study. Eur J Oncol Nurs 2018; 36:129-134. [PMID: 30322503 DOI: 10.1016/j.ejon.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 07/13/2018] [Accepted: 08/17/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Due to improved survival rates of childhood cancer, there has been growing attention to survivors. In addition, experiences of illness in youth, during growth and development, affect the lives of these individuals in numerous ways. With a sample of long-term survivors of childhood cancer, this study investigated their difficult experiences after treatment completion and provided fundamental data for intervention programs that can assist growth. METHODS Data from 15 survivors aged 15-28 years old were collected through face-to-face interviews; analysis used Giorgi's phenomenological method. RESULTS The long-term survivors' lives involved a process of struggle to overcome the difficulties. Survivors had physical vestiges of cancer treatments, such as physical strength limitations, appearance changes, and sexual problems. Additionally, they experienced social withdrawal and awkwardness due to adaptation difficulties caused by social life interruption, family issues, social prejudice, and discrimination. These physical and social struggles led to experiences of mental stress and psychological withdrawal, but were followed by rebound. CONCLUSIONS Long-term survivors of childhood cancer experienced physical, social, and emotional struggles following treatment completion. These results can yield improved understanding of this population, facilitate attention to their challenges, and contribute to their more effective integration into society, helping them live healthy and positive lives.
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38
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Elsbernd A, Pedersen KJ, Boisen KA, Midtgaard J, Larsen HB. “On Your Own”: Adolescent and Young Adult Cancer Survivors' Experience of Managing Return to Secondary or Higher Education in Denmark. J Adolesc Young Adult Oncol 2018; 7:618-625. [DOI: 10.1089/jayao.2018.0058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abbey Elsbernd
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Kaspar Jessen Pedersen
- Department of Pediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Arntz Boisen
- Department of Pediatrics and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Midtgaard
- The University Hospitals' Centre for Health Research (UCSF), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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39
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Crom DB, Ness KK, Martinez LR, Hebl MR, Robison LL, Hudson MM, Brinkman TM. Workplace experiences and turnover intention among adult survivors of childhood cancer. J Cancer Surviv 2018; 12:469-478. [PMID: 29550965 PMCID: PMC6054557 DOI: 10.1007/s11764-018-0686-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate workplace experiences and turnover intention (consideration of leaving or changing a job) and to examine factors associated with turnover intention among survivors. METHODS Adult survivors of childhood cancer with a history of employment (n = 289) completed measures of workplace experiences (n = 50, 18-29 years; n = 183, 30-44 years; n = 56; > 45 years of age at follow-up). Turnover intention was assessed using three items from the Job Satisfaction Scale. Responses were dichotomized as reflecting high vs. low turnover intention. Path analysis was used to estimate the influence of demographic characteristics, treatment exposures (cranial radiation therapy [CRT]), and workplace experiences on turnover intention. RESULTS Thirty percent of survivors reported high turnover intention (95% CL, 25 to 36%). Exposure to CRT (P = 0.003), older attained age (P < 0.001), experiencing formal workplace discrimination (P = 0.008), and having lower continuance (P < 0.001) or affective commitment (P < 0.001) were associated with high turnover intention among survivors. Informal discrimination, mediated through job satisfaction, also influenced survivors' reported intent to leave their jobs. CONCLUSIONS One third of adult survivors of childhood cancer report turnover intention, which is related to their cancer treatment, but more temporally proximal, workplace discrimination. Additional research is needed to understand the consequences of turnover intention among survivors. IMPLICATIONS FOR CANCER SURVIVORS Survivors and their health care providers should be aware of legislative policies related to workplace discrimination (e.g., American with Disabilities Act) and related implications for job turnover.
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Affiliation(s)
- Deborah B Crom
- Department of Oncology, Division of Cancer Survivorship, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Larry R Martinez
- Department of Psychology, Portland State University, Portland, OR, USA
| | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Oncology, Division of Cancer Survivorship, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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40
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Nathan PC, Henderson TO, Kirchhoff AC, Park ER, Yabroff KR. Financial Hardship and the Economic Effect of Childhood Cancer Survivorship. J Clin Oncol 2018; 36:2198-2205. [DOI: 10.1200/jco.2017.76.4431] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In addition to the long-term physical and psychological sequelae of cancer therapy, adult survivors of childhood cancer are at an elevated risk for financial hardship. Financial hardship can have material, psychological, and behavioral effects, including high out-of-pocket medical costs, asset depletion and debt, limitations in or inability to work, job lock, elevated stress and worry, and a delaying or forgoing of medical care because of cost. Most financial hardship research has been conducted in survivors of adult cancers. The few studies focused on childhood cancer survivors have shown that these individuals are at elevated risk for having difficulties with affording needed health care and report high out-of-pocket medical expenses, difficulty with paying medical bills, or consideration of filing for bankruptcy. Childhood cancer survivors are more likely to be unable to work or to have missed work because of poor health. They are more likely to report difficulties with obtaining insurance coverage and rely more frequently on government-sponsored insurance. Globally, countries able to provide curative cancer therapies have witnessed a growing population of survivors, which places a burden on their health care systems because survivors are more likely to require hospitalization and experience a higher burden of chronic illness than the general population. Guidelines for surveillance for late effects are intended to reduce the burden of morbidity, but research is needed to determine whether such surveillance is cost effective. Of note, risk-based survivor care should include routine surveillance for financial hardship. Improved measures of financial hardship, enhanced data infrastructure, and research studies to identify survivors and families most vulnerable to financial hardship and adverse health outcomes will inform the development of targeted programs to serve as a safety net for those at greatest risk.
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Affiliation(s)
- Paul C. Nathan
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - Tara O. Henderson
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - Anne C. Kirchhoff
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - Elyse R. Park
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - K. Robin Yabroff
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
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41
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Compas BE, Jaser SS, Reeslund K, Patel N, Yarboi J. Neurocognitive deficits in children with chronic health conditions. ACTA ACUST UNITED AC 2018; 72:326-338. [PMID: 28481580 DOI: 10.1037/amp0000042] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over 4 million children in the United States suffer from chronic health conditions, including cancer, sickle cell disease, and diabetes. Because of major advances in the early identification and treatment of these conditions, survival rates for these children continue to rise, and the majority now lives into adulthood. However, increases in survival have come with costs related to long-term effects of disease processes and treatments. Foremost among these consequences is impairment in brain development and neurocognitive function that may affect a substantial portion of children with chronic health conditions and follow many into adulthood. Impaired cognitive function may contribute to impairment in educational and occupational attainment, mental health, and quality of life for children with chronic conditions. Despite the significance and scope of this problem, advances in the identification and understanding of neurocognitive problems and the delivery of effective clinical care have been hindered in part because research has been "siloed"-conducted on each chronic condition in isolation. This review examines, for the first time, neurocognitive problems in a selected set of 6 chronic pediatric health conditions-leukemia, brain tumors, sickle cell disease, congenital heart disease, Type 1 diabetes, and traumatic brain injury-to define the magnitude of the problem and identify directions for future research and clinical care. Psychologists from many areas of specialization, including pediatric psychology, educational and school psychology, neuropsychology, behavioral medicine, and adult primary care, are uniquely positioned to contribute to every phase of this work, including research, identification, and intervention. (PsycINFO Database Record
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Affiliation(s)
- Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University
| | | | - Kristen Reeslund
- Department of Psychology and Human Development, Vanderbilt University
| | - Niral Patel
- Department of Pediatrics, Vanderbilt University
| | - Janet Yarboi
- Department of Psychology and Human Development, Vanderbilt University
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Abstract
Patients with brain tumor exhibit wide-ranging prognoses and functional implications of their disease and treatments. In general, the supportive care needs of patients with brain tumor, including disabling effects, have been recognized to be high. This review (1) briefly summarizes brain tumor types, treatments, and prognostic information for the rehabilitation clinician; (2) reviews evidence for rehabilitation, including acute inpatient rehabilitation and cognitive rehabilitation, and the approaches to selected common symptom and medical management issues; and (3) examines emerging data about survivorship, such as employment, community integration, and fitness.
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Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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43
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Dixon SB, Bjornard KL, Alberts NM, Armstrong GT, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Fernandez-Pineda I, Force LM, Gibson TM, Green DM, Howell CR, Kaste SC, Kirchhoff A, Klosky JL, Krull KR, Lucas JT, Mulrooney DA, Ness KK, Wilson CL, Yasui Y, Robison LL, Hudson MM. Factors influencing risk-based care of the childhood cancer survivor in the 21st century. CA Cancer J Clin 2018; 68:133-152. [PMID: 29377070 PMCID: PMC8893118 DOI: 10.3322/caac.21445] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022] Open
Abstract
The population of adult survivors of childhood cancer continues to grow as survival rates improve. Although it is well established that these survivors experience various complications and comorbidities related to their malignancy and treatment, this risk is modified by many factors that are not directly linked to their cancer history. Research evaluating the influence of patient-specific demographic and genetic factors, premorbid and comorbid conditions, health behaviors, and aging has identified additional risk factors that influence cancer treatment-related toxicity and possible targets for intervention in this population. Furthermore, although current long-term follow-up guidelines comprehensively address specific therapy-related risks and provide screening recommendations, the risk profile of the population continues to evolve with ongoing modification of treatment strategies and the emergence of novel therapeutics. To address the multifactorial modifiers of cancer treatment-related health risk and evolving treatment approaches, a patient-centered and risk-adapted approach to care that often requires a multidisciplinary team approach, including medical and behavioral providers, is necessary for this population. CA Cancer J Clin 2018;68:133-152. © 2018 American Cancer Society.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine – Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Lisa M Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sue C Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Anne Kirchhoff
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - James L Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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44
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Winterling J, Johansson E, Wettergren L, Ljungman P, Alexanderson K. Occupational status among adult survivors following allogeneic stem cell transplantation in childhood. Eur J Cancer Care (Engl) 2018; 27:e12808. [PMID: 29315926 DOI: 10.1111/ecc.12808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Abstract
This study examined occupational status and factors associated with sick leave and disability pension among adult long-term survivors previously treated with allogeneic stem cell transplantation (allo-SCT) during childhood. Moreover, occupational status was compared to that of a reference group. Data were collected with questionnaires and from medical records. The SCT group included 59 adults (18-45 years old: response rate 63%) treated with allo-SCT in childhood with a median of 17 (range 3-28) years earlier. The reference group included 296 individuals randomly selected from the general population. The results show that 54% of the long-term survivors were working part- or full-time and that 19% were on sick leave or disability pension. A larger proportion of the SCT group was on sick leave or disability pension (19% vs. 6%: p < .001) than of the reference group. The logistic regression analysis revealed that being on sick leave or disability pension among long-term survivors was associated with late effects related to the allo-SCT (OR 12.28: 95% CI 1.3-111.6: p = .03). The results underscore that long-term survivors' engagement in paid work is influenced many years after treatment and highlights the need to include vocational assistance in the rehabilitation following allo-SCT in childhood.
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Affiliation(s)
- Jeanette Winterling
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Center of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Johansson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena Wettergren
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Center of Haematology, Karolinska University Hospital, Stockholm, Sweden.,Division of Haematology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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45
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Peñas-Felizzola OL, Parra-Esquivel EI, Gómez-Galindo AM. [Occupational therapy in oncology: experiences in academic practices and literature review]. Rev Salud Publica (Bogota) 2018; 20:45-52. [PMID: 30183884 DOI: 10.15446/rsap.v20n1.62227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/15/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To inquire about the training of occupational therapists in oncology in a university program, and to identify updated literature as evidence for training and professional practice. MATERIALS AND METHODS Cross-sectional exploratory study, with a sample of 29 students of occupational therapy from the National University of Colombia. Systematic review of literature 2010-2015 on occupational therapy interventions in oncology. Results In the survey, less than a quarter of the students reported having received training on clinical management of this diagnosis, and on the intervention of the occupational therapist with such cases (24.1%). Little more than this percentage (27.6%), has had users with cancer in their academic practices. In the literature review no national publications were found, although there were unpublished products from Colombian universities. Fifty-four international publications were recovered, especially in rehabilitation, it followed by psychosocial and socio-occupational areas. The palliative care, the multidisciplinarity, the subjective experience of the patient in relation to the diagnosis and treatment, the humanized and integral care from the different areas of the therapeutic task and work with caregivers are considered as relevant issues in the oncological patient's approach. CONCLUSIONS Reference points are made for the occupational therapy curriculum development and for professional updating processes, which are both competence of the academy and of the guild. It is important to intervene in cancer not only during, but in the preparation to treatment and subsequently with survivors. Professional publications should be encouraged, making sure they provide powerful evidence of the impact of occupational therapy and oncological rehabilitation.
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Affiliation(s)
- Olga L Peñas-Felizzola
- OP: TO. Esp. Análisis de Políticas Públicas. M. Sc. Salud Pública. Ph. D.(c) Estudios Políticos. Profesora, Departamento de la Ocupación Humana, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Eliana I Parra-Esquivel
- EP: TO. Certificada en Integración Sensorial, M. Sc. Educación. Ph. D.(c) Educación. Profesora, Departamento de la Ocupación Humana, Universidad Nacional de Colombia. Bogotá, Colombia.
| | - Ana M Gómez-Galindo
- AG: TO. M. Sc. Educación. Profesora, Departamento de la Ocupación Humana. Universidad Nacional de Colombia. Bogotá, Colombia.
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46
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Mader L, Michel G, Roser K. Unemployment Following Childhood Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:805-812. [PMID: 29229046 PMCID: PMC5736865 DOI: 10.3238/arztebl.2017.0805] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 03/24/2017] [Accepted: 08/08/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Childhood cancer survivors are at risk of physical and mental long-term sequelae that may interfere with their employment situation in adulthood. We updated a systematic review from 2006 and assessed unemployment in adult childhood cancer survivors compared to the general population, and its predictors. METHODS Systematic literature searches for articles published between February 2006 and August 2016 were performed in CINAHL, EMBASE, PubMed, PsycINFO, and SocINDEX. We extracted unemployment rates in studies with and without population controls (controlled /uncontrolled studies). Unemployment in controlled studies was evaluated using a meta-analytic approach. RESULTS We included 56 studies, of which 27 were controlled studies. Approximately one in six survivors was unemployed. The overall meta-analysis of controlled studies showed that survivors were more likely to be unemployed than controls (Odds Ratio [OR] = 1.48, 95% confidence interval [CI]: [1.14; 1.93]). Elevated odds were found in survivors in the US and Canada (OR = 1.86, 95% CI: [1.26; 2.75]), as well as in Europe (OR = 1.39, 95% CI: [0.97; 1.97]). Survivors of brain tumors in particular were more likely to be unemployed (OR = 4.62, 95% CI: [2.56; 8.31]). Narrative synthesis across all included studies revealed younger age at study and diagnosis, female sex, radiotherapy, and physical late effects as further predictors of unemployment. CONCLUSION Childhood cancer survivors are at considerable risk of unemployment in adulthood. They may benefit from psycho-social care services along the cancer trajectory to support labor market integration.
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Affiliation(s)
- Luzius Mader
- Department of Health Sciences & Health Policy, University of Luzern, Switzerland
| | - Gisela Michel
- Department of Health Sciences & Health Policy, University of Luzern, Switzerland
| | - Katharina Roser
- Department of Health Sciences & Health Policy, University of Luzern, Switzerland
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47
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Ehrhardt MJ, Mulrooney DA, Li C, Baassiri MJ, Bjornard K, Sandlund JT, Brinkman TM, Huang IC, Srivastava DK, Ness KK, Robison LL, Hudson MM, Krull KR. Neurocognitive, psychosocial, and quality-of-life outcomes in adult survivors of childhood non-Hodgkin lymphoma. Cancer 2017; 124:417-425. [PMID: 28915338 DOI: 10.1002/cncr.31019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/11/2017] [Accepted: 08/21/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with non-Hodgkin lymphoma (NHL) undergo treatment with central nervous system-directed therapy, the potentially neurotoxic effects of which have not been reported in NHL survivors. METHODS NHL survivors (n = 187) participating in the St. Jude Lifetime Cohort who were 10 or more years from their diagnosis and were 18 years old or older underwent neurocognitive, emotional distress (Brief Symptom Inventory 18), and health-related quality of life (HRQOL) assessments (36-Item Short Form Health Survey). Age-adjusted z scores were compared with community controls (n = 181) and normative data. Treatment exposures were abstracted from medical records. Models adjusted for the age, sex, and time from diagnosis were used to calculate the risk of impairment. RESULTS The mean ages at evaluation were similar for the survivors and the controls (35.7 ± 8.9 vs 35.5 ± 11.0 years; P = .86). Survivors were 25.2 ± 8.8 years from their diagnosis: 43 (23%) received cranial radiation, 70 (37%) received high-dose methotrexate, 40 (21%) received high-dose cytarabine, and 151 (81%) received intrathecal chemotherapy. Survivors' intelligence and attention were within normal limits; however, their memory, executive function, processing speed, and academics were impaired in comparison with both population norms and community controls (P values < .05). Treatment-related exposures were not associated with neurocognitive function; however, neurocognitive impairment was associated with lower educational attainment, unemployment, and occupational status (P values < .03). Slower processing speed and worse self-reported executive function were associated with symptoms of depression (P values ≤ .003) and poorer HRQOL (P values < .05). CONCLUSIONS Adult survivors of childhood NHL experience impaired neurocognitive function, which is associated with lower social attainment and poor HRQOL. Early-detection and intervention strategies are recommended. Cancer 2017. © 2017 American Cancer Society.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Malek J Baassiri
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Kari Bjornard
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John T Sandlund
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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48
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Kim Y. Exploration of life experiences of positive growth in long-term childhood cancer survivors. Eur J Oncol Nurs 2017; 30:60-66. [PMID: 29031315 DOI: 10.1016/j.ejon.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/01/2017] [Accepted: 08/11/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to explore experiences of positive growth in long-term childhood cancer survivors, from their perspective. METHODS Fifteen long-term survivors of childhood cancer provided descriptions of their experiences. Data were collected through face-to-face interviews and the analysis was based on Giorgi's phenomenological research method. RESULTS The analysis of positive growth experienced by long-term childhood cancer survivors revealed three themes: self-directed life, normalcy in life, and inner maturity. Long-term survivors defined positive growth as a successful transition to a self-satisfactory life based on motivation acquired through their cancer experience and on subjective goal-setting, as well as becoming cancer-free and living a normal life within society. They seemed to have acquired optimistic, flexible, active attitudes toward life while demonstrating profound gratefulness and consideration of people around them, as well as prudent approaches to health. CONCLUSIONS The findings of this study verified that long-term survivors of childhood cancer have grown positively due to their negative past experience. We expect these findings to contribute to the development of programs that promote positive growth in long-term childhood cancer survivors.
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Affiliation(s)
- Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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49
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Agnew F, Higgins A, Casey M, McCarthy A. The experience of fatherhood following childhood cancer survival. J Health Psychol 2017; 25:340-349. [DOI: 10.1177/1359105317717598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the experience of becoming a father following childhood cancer survival. Semi-structured interviews were conducted with five fathers and analysed using interpretative phenomenological analysis. Three superordinate themes emerged: ‘moving away from and revisiting the experience of cancer’, ‘making sense of fortune and loss following a life-threatening illness’ and ‘valuing the opportunity to be a father’. The transition to fatherhood brought unique and specific challenges to fathers. Nevertheless, all appeared to have positively adjusted to this transition. Findings recommended providing information and support to childhood survivors who wish to or who are about to become fathers.
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Affiliation(s)
- Francis Agnew
- Belfast Health and Social Care Trust, UK
- Queen’s University Belfast, UK
| | - Aiveen Higgins
- Queen’s University Belfast, UK
- Antrim Area Hospital, Northern Health & Social Care Trust
| | - Maureen Casey
- Royal Belfast Hospital for Sick Children, UK
- Brothers of Charity, Lota, Glanmire, Co Cork, Ireland
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50
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Dumas A, Berger C, Auquier P, Michel G, Fresneau B, Allodji RS, Haddy N, Rubino C, Vassal G, Valteau-Couanet D, Thouvenin-Doulet S, Casagranda L, Pacquement H, El-Fayech C, Oberlin O, Guibout C, de Vathaire F. Educational and occupational outcomes of childhood cancer survivors 30 years after diagnosis: a French cohort study. Br J Cancer 2017; 114:1060-8. [PMID: 27115571 PMCID: PMC4984908 DOI: 10.1038/bjc.2016.62] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/04/2016] [Accepted: 02/18/2016] [Indexed: 11/09/2022] Open
Abstract
Background: Although survival from childhood cancer has increased, little is known on the long-term impact of treatment late effects on occupational attainment or work ability. Methods: A total of 3512 five-year survivors treated before the age of 19 years in 10 French cancer centres between 1948 and 2000 were identified. Educational level, employment status and occupational class of survivors were assessed by a self-reported questionnaire. These outcome measures were compared with sex–age rates recorded in the French population, using indirect standardisation. Paternal occupational class was also considered to control for the role of survivors' socioeconomic background on their achievement. Multivariable analyses were conducted to explore clinical characteristics associated with the outcomes. Results: A total of 2406 survivors responded to the questionnaire and survivors aged below 25 years were included in the current analysis. Compared with national statistics adjusted on age and sex, male survivors were more likely to be college graduates (39.2% vs 30.9% expected; P<0.001). This higher achievement was not observed either for leukaemia or central nervous system (CNS) tumour survivors. Health-related unemployment was higher for survivors of CNS tumour (28.1% vs 4.3% P<0.001) but not for survivors of other diagnoses. Survivors of non-CNS childhood cancer had a similar or a higher occupational class than expected. Conclusions: Survivors treated for CNS tumour or leukaemia, especially when treatment included cranial irradiation, might need support throughout their lifespan.
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Affiliation(s)
- Agnes Dumas
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Social and Human Sciences Research Unit, Gustave Roussy, 94805 Villejuif, France
| | - Claire Berger
- Department of Paediatric Haematology-Oncology, CHU Saint-Etienne, 42270 Saint-Priest-en-Jarez, France.,Rhône-Alpes Childhood Cancer Registry, 42000 Saint-Etienne, France.,Laboratory SNA-EPIS EA4607, Jean Monnet University), 42000 Saint-Etienne, France
| | - Pascal Auquier
- Quality of Life Research Unit (EA3279), APHM, Aix Marseille University, 13385 Marseille, France
| | - Gérard Michel
- Quality of Life Research Unit (EA3279), APHM, Aix Marseille University, 13385 Marseille, France.,Department of Paediatric Haematology-Oncology, La Timone, 13005 Marseille, France
| | - Brice Fresneau
- Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France
| | - Rodrigue Sètchéou Allodji
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.,Paris XI University
| | - Nadia Haddy
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.,Paris XI University
| | - Carole Rubino
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.,Paris XI University
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France
| | | | - Sandrine Thouvenin-Doulet
- Department of Paediatric Haematology-Oncology, CHU Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Léonie Casagranda
- Rhône-Alpes Childhood Cancer Registry, 42000 Saint-Etienne, France.,Laboratory SNA-EPIS EA4607, Jean Monnet University), 42000 Saint-Etienne, France
| | - Hélène Pacquement
- Department of Paediatric Oncology, Institut Curie, 75005 Paris, France
| | - Chiraz El-Fayech
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France
| | - Odile Oberlin
- Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805 Villejuif, France
| | - Catherine Guibout
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.,Paris XI University
| | - Florent de Vathaire
- CESP (Centre for Research in Epidemiology and Population Health) U1018, Inserm, 94807 Villejuif, France.,Department of Clinical Research, Gustave Roussy, 94805 Villejuif, France.,Paris XI University
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