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Neves MC, Monteiro S, Prins JB, Sales CMD. Informed Consent and Adolescents with Cancer: Challenges and Tools in Online Studies. J Adolesc Young Adult Oncol 2024. [PMID: 38959165 DOI: 10.1089/jayao.2023.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Affiliation(s)
- Maria Carolina Neves
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Sara Monteiro
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- Department of Social Sciences and Management, Open University, Lisboa, Portugal
- Center for Global Studies, Open University, Lisboa, Portugal
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Célia M D Sales
- Center for Psychology at the University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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2
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Gutierrez AM, Robinson JO, Raesz-Martinez R, Canfield I, Majumder MA, Scollon S, Desrosiers LR, Hsu RL, Allen-Rhoades W, Parsons DW, Plon SE, McGuire AL, Malek J. Views of Adolescents and Young Adults with Cancer and Their Oncologists Toward Patients' Participation in Genomic Research. J Adolesc Young Adult Oncol 2023; 12:773-781. [PMID: 36595372 PMCID: PMC10611971 DOI: 10.1089/jayao.2022.0066] [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] [Indexed: 01/04/2023] Open
Abstract
Purpose: With increased use of genomic testing in cancer research and clinical care, it is important to understand the perspectives and decision-making preferences of adolescents and young adults (AYAs) with cancer and their treating oncologists. Methods: We conducted an interview substudy of the BASIC3 Study, which enrolled newly diagnosed cancer patients <18 years of age with assent. Of 32 young adults (YAs) with cancer who reached the age of majority (AOM; 18 years) while on study, 12 were successfully approached and all consented to study continuation at AOM. Of those, seven completed an interview. Patients' oncologists, who enrolled and participated in return of clinical genomic results, were also interviewed (n = 12). Interviews were transcribed, deidentified, and analyzed using thematic analysis. Results: YAs cited the possibility of helping others and advancing science as major reasons for their assent to initial study enrollment and their willingness to consent at AOM. YAs thought obtaining informed consent from research participants for study continuation at AOM was a good idea in case they changed their minds or wanted to make their own decisions, and to keep them aware of study activities. There was diversity in what YAs understood and learned from genomic testing: some recalled specific findings, while some remembered minimal information about their results. Oncologists varied in their assessment of adolescents' engagement with the study and understanding of their results. Conclusion: Given the different ways AYAs engage with genomic information, careful assessment of AYAs' diverse communication and decision-making preferences is needed to tailor interactions accordingly.
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Affiliation(s)
- Amanda M. Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Jill O. Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Robin Raesz-Martinez
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Isabel Canfield
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Mary A. Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Scollon
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lauren R. Desrosiers
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rebecca L. Hsu
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Wendy Allen-Rhoades
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - D. Williams Parsons
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sharon E. Plon
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Janet Malek
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
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3
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Wurz A, McLaughlin E, Hughes K, Ellis K, Chen A, Cowley L, Molina H, Duchek D, Eisele M, Culos-Reed SN. Exploring feasibility, perceptions of acceptability, and potential benefits of an 8-week yoga intervention delivered by videoconference for young adults affected by cancer: a single-arm hybrid effectiveness-implementation pilot study. Pilot Feasibility Stud 2023; 9:37. [PMID: 36899410 PMCID: PMC9999078 DOI: 10.1186/s40814-023-01244-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/12/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Young adults affected by cancer face physical and psychological challenges and desire online supportive care. Yoga can be delivered online and may improve physical and psychological outcomes. Yet, yoga has rarely been studied with young adults affected by cancer. To address this, an 8-week yoga intervention was developed, and a pilot study was deemed necessary to explore feasibility, acceptability, implementation, and potential benefits. METHODS A mixed-methods, single-arm hybrid effectiveness-implementation pilot study evaluating the yoga intervention was conducted. Feasibility was assessed by tracking enrollment, retention, attendance, completeness of data, and adverse events. Acceptability was explored through interviews. Implementation metrics included training time, delivery resources, and fidelity. Potential effectiveness was evaluated by exploring changes in physical (i.e., balance, flexibility, range of motion, functional mobility) and psychological (i.e., quality of life, fatigue, resilience, posttraumatic growth, body image, mindfulness, perceived stress) outcomes at pre- (week 0), post- (week 8), and follow-up (week 16) time points. Data were analyzed with descriptive statistics, repeated measures analysis of variance, and content analysis. RESULTS Thirty young adults participated in this study (recruitment rate = 33%). Retention to study procedures was 70%, and attendance ranged from 38 to 100%. There were little missing data (< 5%) and no adverse events. Though most participants were satisfied with the yoga intervention, recommendations for improvement were shared. Sixty study-specific training hours and > 240 delivery and assessment hours were accrued and fidelity was high. Functional mobility, flexibility, quality of life (energy/fatigue, social well-being), body image (appearance evaluation), mindfulness (non-reactivity), and perceived stress improved significantly over time (all p< 0.050; [Formula: see text]). No other significant changes were observed (all p> 0.050; [Formula: see text]). CONCLUSIONS The yoga intervention may confer physical and psychological benefits, though intervention and study-specific modifications are required to improve feasibility and acceptability. Requiring study participation and providing greater scheduling flexibility could enhance recruitment and retention. Increasing the frequency of classes offered each week and offering more opportunities for participant interaction could improve satisfaction. This study highlights the value of doing pilot work and provides data that has directly informed intervention and study modifications. Findings could also be used by others offering yoga or supportive care by videoconference to young adults affected by cancer. TRIAL REGISTRATION Not available-not registered.
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Affiliation(s)
- Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, Canada. .,Faculty of Kinesiology, University of Calgary, Calgary, Canada.
| | - Emma McLaughlin
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Kimberly Hughes
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Kelsey Ellis
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Amy Chen
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | | | - Delaney Duchek
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, Canada
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4
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Short- and long-term impact of cancer on employment and financial outcomes of adolescents and young adults (AYAs): a large population-based case-control registry study in the Netherlands. ESMO Open 2022; 7:100521. [PMID: 35772237 PMCID: PMC9434129 DOI: 10.1016/j.esmoop.2022.100521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/24/2022] Open
Abstract
Background Adolescent and young adult (AYA) cancer survivors, 18-39 years at initial cancer diagnosis, often self-report negative consequences of cancer (treatment) for their career. Less is known, however, about the objective impact of cancer on employment and financial outcomes. This study examines the employment and financial outcomes of AYA cancer survivors with nationwide population-based registry data and compares the outcomes of AYAs with cancer with an age- and sex-matched control population at year of diagnosis, 1 year later (short-term) and 5 years later (long-term). Patients and methods A total of 2527 AYAs, diagnosed in 2013 with any invasive tumor type and who survived for 5 years, were identified from the Netherlands Cancer Registry (clinical and demographic data) and linked to Statistics Netherlands (demographic, employment and financial data). AYAs were matched 1 : 4 with a control population based on age and sex (10 108 controls). Analyses included descriptive statistics, chi-square tests, independent samples t-tests, McNemar tests and logistic regression. Results AYA cancer survivors were significantly less often employed compared with their controls 1 year (76.1% versus 79.5%, P < 0.001) and 5 years (79.3% versus 83.5%, P < 0.001) after diagnosis, and received more often disability benefits (9.9% versus 3.1% 1 year after diagnosis, P < 0.001; 11.2% versus 3.8% 5 years after diagnosis, P < 0.001). Unemployed AYAs were more often diagnosed with higher disease stages (P < 0.001), treated with chemotherapy (P < 0.001), radiotherapy (P < 0.001) or hormone therapy (P < 0.05) and less often with local surgery (P < 0.05) compared with employed AYAs 1 and 5 years after diagnosis. Conclusion Based on objective, nationwide, population-based registry data, AYAs’ employment and financial outcomes are significantly affected compared with age- and sex-matched controls, both short and long-term after cancer diagnosis. Providing support regarding employment and financial outcomes from diagnosis onwards may help AYAs finding their way (back) into society. Based on objective data, AYAs’ employment and financial outcomes are significantly affected compared with matched controls. AYAs were significantly more often unemployed compared with their controls 1 and 5 years after diagnosis. AYAs received significantly more often disability benefits compared with their controls 1 and 5 years after diagnosis.
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Davies JP, McGill BC, Sansom-Daly UM, Wakefield CE, Kelly DM. "This Is the First Time I've Talked About This": Considerations When Conducting Qualitative Research Interviews with Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:540-548. [PMID: 33393866 DOI: 10.1089/jayao.2020.0122] [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] [Indexed: 01/19/2023] Open
Abstract
Qualitative research is a useful and important way to describe and analyze the experiences of adolescents and young adults (AYAs) with cancer. However, undertaking qualitative research with AYAs living with, or beyond, a cancer diagnosis requires careful planning and a well-informed approach for participants with a high level of vulnerability and who are at a crucial stage developmentally. This article reflects on the challenges of including AYAs with cancer between the ages of 16 and 25 years in qualitative research. By drawing on each author's own experiences of engaging in qualitative research interviews with AYAs with cancer, the article provides suggestions regarding how best to manage challenges and yield valuable data describing their experiences. Insights that are shared between qualitative researchers in this field may assist in preparing for the challenges posed by conducting qualitative research with this group and may help researchers to manage this activity successfully.
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Affiliation(s)
- Jane P Davies
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Daniel M Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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6
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Tanenbaum HC, Wolfson J, Xu L, Hahn EE, Bhatia S, Cannavale K, Cooper R, Chao C. Adherence to cardiomyopathy screening guidelines among adolescent and young adult cancer survivors exposed to chest radiation and/or anthracyclines. J Cancer Surviv 2020; 15:738-747. [PMID: 33170480 DOI: 10.1007/s11764-020-00965-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Cancer survivors are at risk for late effects from therapeutic exposures, including cardiovascular complications. To improve outcomes among adolescents and young adults (AYA) with cancer, the National Comprehensive Cancer Network (NCCN) released guidelines for screening services (based on the Children's Oncology Group Long-Term Follow-Up [LTFU] guidelines) for survivors of AYA cancer. To better understand survivorship care gaps, we conducted a baseline evaluation of cardiomyopathy screening among survivors of AYA cancers. METHODS Members of Kaiser Permanente Southern California diagnosed with cancer between ages 15 and 39 from 2000 to 2010 with at least 5-year survival after diagnosis who were exposed to chest radiation and/or anthracyclines were included. We calculated the Prevention Index ([PI], proportion of person-time covered by receipt of preventive services relative to the total person-time eligible) to evaluate adherence to recommended cardiomyopathy screenings based on the LTFU through 2016. Predictors for screening were evaluated in multivariable logistic regression. RESULTS Among 479 survivors recommended for cardiomyopathy screening, 28 received at least one screening, and the mean PI was 2.38% (SD = 13.05%, median = 0.00%). Compared to stage I, survivors of stage II (odds ratio [OR] = 5.56 [1.05-29.46]) and stage III/IV cancer (OR = 6.08 [1.10-33.54]) were more likely to receive cardiomyopathy screening. CONCLUSIONS Cardiomyopathy screening among survivors was low around the time when NCCN AYA oncology guidelines were released. IMPLICATIONS FOR CANCER SURVIVORS Our study highlights significant room for improvement for adherence to cardiomyopathy screening recommendations among survivors of AYA cancer. Attention is needed to ensure that recommended cardiomyopathy screenings are met for better management of cardiomyopathy late effects.
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Affiliation(s)
| | - Julie Wolfson
- School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc., 6848 Silkwood Ln, Solon, OH, 44139, USA
| | - Erin E Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Smita Bhatia
- School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA
| | - Kimberly Cannavale
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Robert Cooper
- Department of Pediatrics-Hematology/Oncology, Kaiser Permanente Southern California, 1526 N Edgemont St, Los Angeles, CA, 90027, USA
| | - Chun Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA.
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7
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Lang MJ, Dort JC, Stephen J, Lamont L, Giese-Davis J. Narrative-Informed, Emotion-Focused Psychotherapy in Synchronous, Online Chat Groups for Adolescents and Young Adults with Cancer: A Proof-of-Concept Study. J Adolesc Young Adult Oncol 2020; 9:676-682. [PMID: 32614264 PMCID: PMC7757545 DOI: 10.1089/jayao.2020.0030] [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] [Indexed: 11/14/2022] Open
Abstract
Few, scalable, evidence-based psychosocial interventions exist for adolescent and young adult cancer survivors (AYAs, 18–39 years old). Using an existing, facilitated, online synchronous chat group-plus-education model (OSG+E), we replaced their educational workbook with an AYA-created film to stimulate an age-specific, emotion-focused group discussion (OSG+V). This randomized proof-of-concept trial compared the two models' content suitability, group processes, and feasibility over 9 months in 34 male and female AYAs with a range of cancers. AYAs rated the OSG + V model more suitable, cohesive, and as having higher levels of important group processes than the OSG+E. A larger randomized trial is feasible for this AYA-appropriate, emotion-focused OSG + V model.
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Affiliation(s)
- Michael J Lang
- Faculty of Nursing and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph C Dort
- Departments of Surgery, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Stephen
- Department of Psychosocial Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa Lamont
- Department of Psychosocial Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Janine Giese-Davis
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, and Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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8
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Pailler ME, Beaupin LK, Brewer-Spritzer E, Grant PC, Depner RM, Levy K, Tenzek KE. Reaching Adolescent and Young Adult Cancer Patients Through Social Media: Impact of the Photographs of Meaning Program. J Adolesc Young Adult Oncol 2020; 9:508-513. [PMID: 32255697 DOI: 10.1089/jayao.2019.0140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study assessed the feasibility and preliminary efficacy of the Photographs of Meaning Program for Adolescent and Young Adult cancer patients and survivors (POM-AYA). Methods: POM-AYA is a structured 10-week meaning-based intervention in which participants post photographs and accompanying narratives through a social media platform. Measures of depression, overall quality of life (QoL), and spiritual well-being were assessed on consent (T1), after completing the 10-week intervention (T2) and 2 months' postintervention (T3). Participants also completed a satisfaction questionnaire and follow-up semi-structured interviews. Results: Thirty AYA cancer patients and survivors (ages 17-36) were enrolled in the study. At T2, depressive symptoms were significantly lower and QoL was significantly higher compared with T1. These gains were maintained at T3. There were no significant differences in reported spiritual well-being across the study period. Overall, participants reported high rates of study satisfaction in both the survey and qualitative feedback. Conclusion: POM-AYA appears to be a potentially beneficial, widely accessible intervention in reducing depressive symptoms and increasing QoL in AYA cancer patients and survivors.
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Affiliation(s)
- Megan E Pailler
- Department of Psychology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Lynda K Beaupin
- Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Erin Brewer-Spritzer
- Department of Psychology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Pei C Grant
- Palliative Care Institute, The Center for Hospice and Palliative Care, Cheektowaga, New York, USA
| | - Rachel M Depner
- Palliative Care Institute, The Center for Hospice and Palliative Care, Cheektowaga, New York, USA.,University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Kathryn Levy
- Palliative Care Institute, The Center for Hospice and Palliative Care, Cheektowaga, New York, USA
| | - Kelly E Tenzek
- University at Buffalo, The State University of New York, Buffalo, New York, USA
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9
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Benedict C, Hahn AL, Diefenbach MA, Ford JS. Recruitment via social media: advantages and potential biases. Digit Health 2019; 5:2055207619867223. [PMID: 31431827 PMCID: PMC6685119 DOI: 10.1177/2055207619867223] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Adolescent and young adult (AYA) cancer survivors are under-represented in research. Social media is increasingly used for recruitment given its ability to reach large audiences. Differences in participant characteristics and potential biases due to recruitment source are not well understood. Purpose This study aimed to: (a) compare recruitment strategies (hospital-based v. social media) in enrollment metrics, and (b) among enrolled participants, evaluate group differences in patient characteristics and patient reported outcomes (PROs). Methods Preliminary data from a cancer and fertility study with female AYAs were evaluated. Hospital-based recruitment used electronic medical records (EMR) to identify eligible patients. Social media recruitment involved posting on partner organizations’ social media outlets. PROs included validated measures related to the parent study. Descriptive statistics evaluated recruitment metrics. Independent samples t-tests and chi-square identified differences in participant characteristics and PROs based on recruitment. Results Social media yielded a higher enrollment rate (37%; n = 54/146) compared with hospital-based recruitment (7%; n = 21/289) and required fewer study resources. Compared with hospital-based recruitment, participants from social media were more likely to be White (p = 0.01), with a longer time since treatment (p = 0.03); and reported higher levels of reproductive concern (p = 0.004) and negative mood (p = 0.02), and more negative illness perceptions (ps < 0.05). Conclusion Recruitment via social media may be a more effective and efficient strategy compared with hospital-based methods. However, group differences were identified that could bias findings and limit generalizability. Advantages of social media should be considered with an understanding of how methodology may impact enrollment and results.
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Affiliation(s)
| | | | | | - Jennifer S Ford
- Hunter College and the Graduate Center, City University of New York (CUNY), USA
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10
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Sansom‐Daly UM, Wakefield CE, Bryant RA, Patterson P, Anazodo A, Butow P, Sawyer SM, McGill BC, Evans HE, Cohn RJ. Feasibility, acceptability, and safety of the Recapture Life videoconferencing intervention for adolescent and young adult cancer survivors. Psychooncology 2018; 28:284-292. [DOI: 10.1002/pon.4938] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/05/2018] [Accepted: 11/04/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Ursula M. Sansom‐Daly
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
- Nelune Comprehensive Cancer CentrePrince of Wales Hospital Sydney Australia
| | - Claire E. Wakefield
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | | | - Pandora Patterson
- Research, Evaluation and Social Policy UnitCanTeen Newtown Australia
- Cancer Nursing Research Unit, Sydney Nursing SchoolThe University of Sydney Sydney Australia
| | - Antoinette Anazodo
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
- Nelune Comprehensive Cancer CentrePrince of Wales Hospital Sydney Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), School of PsychologyUniversity of Sydney Sydney Australia
| | - Susan M. Sawyer
- Department of PaediatricsUniversity of Melbourne Melbourne Australia
- Murdoch Children's Research Institute Melbourne Australia
- Royal Children's Hospital Centre for Adolescent Health Melbourne Australia
| | - Brittany C. McGill
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | - Holly E. Evans
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | - Richard J. Cohn
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
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11
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Psihogios AM, Pauly-Hubbard H, Schwartz L, Ginsberg JP, Hobbie W, Szalda D. Understanding and Improving Knowledge of Cancer Survivorship Care Among College Providers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1075-1081. [PMID: 28299542 DOI: 10.1007/s13187-017-1208-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aimed to assess college providers' basic knowledge of the health risks of young adult cancer survivors (YAS) and related care guidelines and to determine whether an educational in-service is an effective platform for increasing college health providers' knowledge about survivorship care at a large university health center. During phase 1, staff from college health centers and office of disabilities in the Philadelphia area (n = 40 staff members from 24 colleges/universities) completed a needs assessment on their experiences with YAS and preferences for education and care coordination. During phase 2, a 1-h educational in-service, informed by results of the survey, was provided to 18 health center medical providers. While most providers indicated that YAS are at risk for chronic health conditions because of cancer treatment, nearly all were unfamiliar with the content of published long-term follow-up guidelines for cancer survivorship. Over half did not have knowledge of cancer survivorship services in their area. All respondents were interested in more education on cancer survivorship care. Attendees of the in-service increased their knowledge of survivorship follow-up guidelines, awareness of local survivorship resources, and comfort with caring for YAS at posttest relative to baseline. The in-service was highly acceptable to providers and feasible to implement. College providers had little baseline knowledge of cancer survivorship guidelines, but were motivated to obtain more information. Through an educational in-service, college health providers may be better equipped to provide acute and longitudinal survivorship care to a vulnerable population who are at risk for inadequate engagement in risk-based follow-up care.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Lisa Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jill P Ginsberg
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy Hobbie
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dava Szalda
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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Fern LA, Taylor RM. Enhancing accrual to clinical trials of adolescents and young adults with cancer. Pediatr Blood Cancer 2018; 65:e27233. [PMID: 29749691 DOI: 10.1002/pbc.27233] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 03/05/2018] [Accepted: 03/16/2018] [Indexed: 12/20/2022]
Abstract
Underrepresentation of young people in cancer research is an international phenomenon and may contribute to poorer outcomes. We sought to identify systematically tested interventions and strategies to improve recruitment. The review identified 13 papers. The following four themes emerged: trial availability/regulatory factors; service configuration/place-of-care factors; recruitment methods and developmental factors specific to young people. We could not identify any studies that had employed prospective interventions to improve recruitment. Without available research studies in which to garner data on adolescents and young adults, we will always be constrained in our ability to provide evidence based care with resultant limitations on our ability to improve outcomes.
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Affiliation(s)
- Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Christen S, Weishaupt E, Vetsch J, Rueegg CS, Mader L, Dehler S, Michel G. Perceived information provision and information needs in adolescent and young adult cancer survivors. Eur J Cancer Care (Engl) 2018; 28:e12892. [DOI: 10.1111/ecc.12892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/03/2018] [Accepted: 06/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Salome Christen
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
| | - Esther Weishaupt
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
| | - Janine Vetsch
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- Discipline of Paediatrics; School of Women's and Children's Health; UNSW Medicine; University of New South Wales; Sydney New South Wales Australia
- Kids Cancer Centre; Sydney Children's Hospital; Sydney New South Wales Australia
| | - Corina S. Rueegg
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- Oslo Centre for Biostatistics and Epidemiology; Oslo University Hospital, and Institute of Basic Medical Sciences; University of Oslo; Oslo Norway
| | - Luzius Mader
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
| | - Silvia Dehler
- Departement Gesundheit und Soziales; Abteilung Gesundheit; Aarau Switzerland
- Cancer Registry Zurich and Zug; Institute of Surgical Pathology; University Hospital Zurich; Zurich Switzerland
- Epidemiology, Biostatistics and Prevention Institute; University Zurich; Zurich Switzerland
| | - Gisela Michel
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- Institute of Social and Preventive Medicine; University of Bern; Bern Switzerland
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Baedorf Kassis S, Gallotto SL, Hess CB, Weyman E, Yock TI. Rethinking reconsent when minors reach adult age in minimal risk studies. Pediatr Blood Cancer 2018; 65. [PMID: 28748629 DOI: 10.1002/pbc.26731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Sylvia Baedorf Kassis
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sara L Gallotto
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Clayton B Hess
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Weyman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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15
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Patient characteristics and outcomes in adolescents and young adults with classical Philadelphia chromosome-negative myeloproliferative neoplasms. Ann Hematol 2017; 97:109-121. [DOI: 10.1007/s00277-017-3165-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/30/2017] [Indexed: 02/01/2023]
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Benedict C, Victorson D, Love B, Fuehrer D, Lazard A, Saffer AJ, Linscott T, Zachary M. The Audacity of Engagement: Hearing Directly from Young Adults with Cancer on Their Attitudes and Perceptions of Cancer Survivorship and Cancer Survivorship Research. J Adolesc Young Adult Oncol 2017; 7:103-111. [PMID: 29022839 DOI: 10.1089/jayao.2017.0038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Young adult (YA) cancer survivors have been historically under-represented in cancer survivorship research, which has contributed to more disparate health outcomes compared with young and older cancer survivors. Using qualitative methods, this study explored YAs' perceptions of cancer survivorship and identified YA-specific barriers and preferences for participation in cancer survivorship research. METHODS Individual interviews and focus groups were conducted with YA cancer survivors (N = 19) attending a patient-focused oncology conference. Grounded theory methodology guided analyses by using an inductive data-driven approach to thematic content analysis. RESULTS Participants averaged 33 years old (standard deviation [SD] = 5.5), were 10 years postdiagnosis (SD = 2.3), and were primarily female (79%). Key cancer survivorship topics included adjusting to a "new normal," staying connected with cancer peers, and dealing with post-treatment medical care. Perceptions of YA survivorship research were mixed. YAs appreciated and were optimistic about the potential for benefit from research. Specific barriers for participation included perceptions of research being inaccessible, overwhelming, and frustrating; participation as inconvenient and burdensome; and researchers being viewed with skepticism and mistrust. They recommended: (1) making age-appropriate, patient-focused changes (e.g., language and design of study materials); (2) increasing participants' control, flexibility, and convenience of procedures; and (3) creating a back-and-forth dialogue between YAs and researchers. CONCLUSION We assessed YA survivors' perceptions of YA cancer survivorship and research. Communication strategies are needed to address negative perceptions and perceived barriers to research participation. This includes tailoring of dissemination efforts and developmentally targeted implementation of YA priorities into the research process. Age-specific, patient-focused research practices may foster trust within the YA cancer survivor community and improve research participation.
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Affiliation(s)
- Catherine Benedict
- 1 Department of Medicine, Hofstra Northwell School of Medicine , Manhasset, New York
| | - David Victorson
- 2 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Northwestern University , Chicago, Illinois
| | - Brad Love
- 3 Center for Health Communication, Moody College of Communication and Dell Medical School, The University of Texas at Austin , Austin, Texas
| | | | - Allison Lazard
- 5 School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Lang MJ, Giese-Davis J, Patton SB, Campbell DJ. Does age matter? Comparing post-treatment psychosocial outcomes in young adult and older adult cancer survivors with their cancer-free peers. Psychooncology 2017; 27:1404-1411. [DOI: 10.1002/pon.4490] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/25/2017] [Accepted: 06/26/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Michael J. Lang
- Department of Community Health Sciences, Cumming School of Medicine (CSM); University of Calgary (UofC); Calgary Canada
| | - Janine Giese-Davis
- Department of Community Health Sciences, Cumming School of Medicine (CSM); University of Calgary (UofC); Calgary Canada
- Department of Oncology; CSM, UofC; Calgary Canada
| | - Scott B. Patton
- Department of Community Health Sciences, Cumming School of Medicine (CSM); University of Calgary (UofC); Calgary Canada
- Department of Psychiatry; CSM, UofC; Calgary Canada
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18
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Hammond C. Against a Singular Message of Distinctness: Challenging Dominant Representations of Adolescents and Young Adults in Oncology. J Adolesc Young Adult Oncol 2017; 6:45-49. [DOI: 10.1089/jayao.2016.0018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chad Hammond
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
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19
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Campo RA, Bluth K, Santacroce SJ, Knapik S, Tan J, Gold S, Philips K, Gaylord S, Asher GN. A mindful self-compassion videoconference intervention for nationally recruited posttreatment young adult cancer survivors: feasibility, acceptability, and psychosocial outcomes. Support Care Cancer 2017; 25:1759-1768. [PMID: 28105523 DOI: 10.1007/s00520-017-3586-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/10/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Young adult (YA) cancer survivors report substantial distress, social isolation, and body image concerns that can impede successful reintegration into life years after treatment completion. Mindful Self-Compassion (MSC) interventions focus on developing mindfulness and self-compassion for managing distress, hardships, and perceived personal inadequacies. An MSC intervention would be beneficial in supporting YA survivors' management of psychosocial challenges that arise in survivorship; however, a telehealth intervention modality is essential for reaching this geographically dispersed population. We conducted a single-arm feasibility study of an MSC 8-week videoconference intervention for nationally recruited YA survivors (ages 18-29). METHODS The MSC intervention was group-based, 90-minute videoconference sessions, held weekly over 8 weeks, with audio-supplemented home practice. Feasibility and acceptability were assessed via attendance rate and an intervention satisfaction scale. Baseline to post-intervention changes in psychosocial outcomes (body image, anxiety, depression, social isolation, posttraumatic growth, resilience, self-compassion, mindfulness) were assessed using paired t tests and Cohen's d effect sizes. RESULTS Thirty-four participants were consented and 25 attended a videoconference group. Feasibility was established with 84% attending at least six of the eight sessions, and intervention acceptability was high (M = 4.36, SD = 0.40, score range = 1-5). All psychosocial outcomes, except for resilience, demonstrated significant changes (p < 0.002), with medium to large effect sizes (Cohen's d > 0.5). CONCLUSION YA survivors are interested in receiving an MSC videoconference intervention. Feasibility, acceptance, and potential psychosocial benefits of the intervention were demonstrated. Findings can be applied toward the design of an efficacy randomized controlled trial to improve quality of life for YA survivors in transition after cancer treatment.
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Affiliation(s)
- Rebecca A Campo
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Karen Bluth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sheila J Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sarah Knapik
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Julia Tan
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Stuart Gold
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Pediatrics and Division of Pediatric Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kamaira Philips
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Susan Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Parsons SK, Guy GP, Peacock S, Cohen JT, Rodday AM, Kiernan EA, Feeny D. Economic Evaluation in Adolescent and Young Adult Cancer: Methodological Considerations and the State of the Science. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Henson KE, Reulen RC, Winter DL, Bright CJ, Fidler MM, Frobisher C, Guha J, Wong KF, Kelly J, Edgar AB, McCabe MG, Whelan J, Cutter DJ, Darby SC, Hawkins MM. Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The Teenage and Young Adult Cancer Survivor Study. Circulation 2016; 134:1519-1531. [PMID: 27821538 PMCID: PMC5106083 DOI: 10.1161/circulationaha.116.022514] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Survivors of teenage and young adult cancer are acknowledged as understudied. Little is known about their long-term adverse health risks, particularly of cardiac disease that is increased in other cancer populations where cardiotoxic treatments have been used. Methods: The Teenage and Young Adult Cancer Survivor Study cohort comprises 200 945 5-year survivors of cancer diagnosed at 15 to 39 years of age in England and Wales from 1971 to 2006, and followed to 2014. Standardized mortality ratios, absolute excess risks, and cumulative risks were calculated. Results: Two thousand sixteen survivors died of cardiac disease. For all cancers combined, the standardized mortality ratios for all cardiac diseases combined was greatest for individuals diagnosed at 15 to 19 years of age (4.2; 95% confidence interval, 3.4–5.2) decreasing to 1.2 (95% confidence interval, 1.1–1.3) for individuals aged 35 to 39 years (2P for trend <0.0001). Similar patterns were observed for both standardized mortality ratios and absolute excess risks for ischemic heart disease, valvular heart disease, and cardiomyopathy. Survivors of Hodgkin lymphoma, acute myeloid leukaemia, genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, leukaemia other than acute myeloid, central nervous system tumour, cervical cancer, and breast cancer experienced 3.8, 2.7, 2.0, 1.7, 1.7, 1.6, 1.4, 1.3 and 1.2 times the number of cardiac deaths expected from the general population, respectively. Among survivors of Hodgkin lymphoma aged over 60 years, almost 30% of the total excess number of deaths observed were due to heart disease. Conclusions: This study of over 200 000 cancer survivors shows that age at cancer diagnosis was critical in determining subsequent cardiac mortality risk. For the first time, risk estimates of cardiac death after each cancer diagnosed between the ages of 15 and 39 years have been derived from a large population-based cohort with prolonged follow-up. The evidence here provides an initial basis for developing evidence-based follow-up guidelines.
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Affiliation(s)
- Katherine E Henson
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Raoul C Reulen
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - David L Winter
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Chloe J Bright
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Miranda M Fidler
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Clare Frobisher
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Joyeeta Guha
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Kwok F Wong
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Julie Kelly
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Angela B Edgar
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Martin G McCabe
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Jeremy Whelan
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - David J Cutter
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Sarah C Darby
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Mike M Hawkins
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D).
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John TD, Sender LS, Bota DA. Cognitive Impairment in Survivors of Adolescent and Early Young Adult Onset Non-CNS Cancers: Does Chemotherapy Play a Role? J Adolesc Young Adult Oncol 2016; 5:226-31. [DOI: 10.1089/jayao.2015.0025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tami D. John
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
- Hyundai Cancer Institute, CHOC Children's Hospital, Orange, California
| | - Leonard S. Sender
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
- Hyundai Cancer Institute, CHOC Children's Hospital, Orange, California
| | - Daniela A. Bota
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
- Department of Neurology, University of California, Irvine, Irvine, California
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Gunnes MW, Lie RT, Bjørge T, Syse A, Ruud E, Wesenberg F, Moster D. Economic independence in survivors of cancer diagnosed at a young age: A Norwegian national cohort study. Cancer 2016; 122:3873-3882. [PMID: 27518040 PMCID: PMC5157778 DOI: 10.1002/cncr.30253] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/18/2016] [Accepted: 07/19/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of cancer on socioeconomic outcomes is attracting attention as the number of survivors of cancer in young age continues to rise. This study examines economic independence in a national cohort of survivors of cancer at a young age in Norway. METHODS Through the linkage of several national registries, the study cohort comprised 1,212,013 individuals born in Norway during 1965 through 1985, of which 5440 had received a cancer diagnosis before age 25 years. Follow-up was through 2007, and the main outcomes were receipt of governmental financial assistance, employment, income, and occupation. Analytic methods included Cox proportional hazard regression, log-binomial regression, and quantile regression models. RESULTS Individuals in the cancer survivor group had an increased probability of receiving governmental financial assistance (men: hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.3-1.5; women: HR, 1.5; 95% CI, 1.3-1.6) and of not being employed (men: HR, 1.4; 95% CI, 1.2-1.7; women: HR, 1.4; 95% CI, 1.2-1.6) compared with those in the noncancer group. Income discrepancies were particularly pronounced for survivors of central nervous system tumors. There was no difference in representation in higher skilled occupations. CONCLUSIONS Survivors of cancer at a young age in Norway had an increased risk of being economically dependent and unemployed. This was evident in several tumor groups and was most pronounced in female survivors. There were only small differences in income or representation in higher skilled occupations for most employed survivors compared with the noncancer group. The current results are important for understanding the impact of a cancer diagnosis at a young age on subsequent job market outcomes. Cancer 2016;122:3873-3882. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Maria W Gunnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Rolv Terje Lie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Bergen, Norway
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Astri Syse
- Department of Research, Statistics Norway, Oslo, Norway
| | - Ellen Ruud
- Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Finn Wesenberg
- Cancer Registry of Norway, Oslo, Norway.,Department of Pediatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Norwegian Institute of Public Health, Bergen, Norway
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Ramphal R, Aubin S, Czaykowski P, De Pauw S, Johnson A, McKillop S, Szwajcer D, Wilkins K, Rogers P. Adolescent and young adult cancer: principles of care. ACTA ACUST UNITED AC 2016; 23:204-9. [PMID: 27330350 DOI: 10.3747/co.23.3013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescents and young adults (ayas) with cancer in active treatment face a number of barriers to optimal care. In the present article, we focus on the 3 critical domains of care for ayas-medical, psychosocial, and research-and how changes to the system could overcome barriers. We summarize the current literature, outline recommended principles of care, raise awareness of barriers to optimal care, and suggest specific changes to the system to overcome those barriers in the Canadian context. Many of the recommendations can nevertheless be applied universally. These recommendations are endorsed by the Canadian Task Force on Adolescents and Young Adults with Cancer and build on outcomes from two international workshops held by that group.
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Affiliation(s)
- R Ramphal
- Division of Pediatric Hematology/Oncology, University of Ottawa, Ottawa, ON
| | - S Aubin
- Division of Gynecologic Oncology, McGill University, Montreal, QC
| | - P Czaykowski
- Division of Hematology/Oncology, University of Manitoba, Winnipeg, MB
| | - S De Pauw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - A Johnson
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, BC Children's Hospital and University of British Columbia, Vancouver, BC
| | - S McKillop
- Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton, AB
| | - D Szwajcer
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB
| | - K Wilkins
- Faculty of Nursing, University of New Brunswick, Fredericton, NB
| | - P Rogers
- Division of Hematology/Oncology, University of Manitoba, Winnipeg, MB
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25
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Heins MJ, Lorenzi MF, Korevaar JC, McBride ML. Non-oncology physician visits after diagnosis of cancer in adolescents and young adults. J Cancer Surviv 2016; 10:783-8. [PMID: 26874737 DOI: 10.1007/s11764-016-0523-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Health care needs of adolescents and young adults (AYAs) with cancer are probably different from other age groups. Studying their non-oncology physician visits in the first years after diagnosis may provide insight into the specific health problems AYA patients experience and thereby help to improve care for these patients. METHODS Seven hundred seventy-four AYAs identified from a Canadian provincial registry diagnosed with cancer between ages 15 and 24 years in 1991/2001 were included, matched by birth year and sex to ten controls. Based on provincial health insurance plan records, we determined the number of family physician and non-cancer specialist visits in the 5 years after diagnosis (for patients) or inclusion (for controls). RESULTS The percentage of patients visiting a non-cancer specialist decreased from 96 to 49 % over the 5-year period. The percentage visiting a family physician decreased from 96 to 84 %. Visits in all years were significantly higher than among controls. In the first year after diagnosis, many patients visited a non-cancer specialist or a family physician for neoplasm-related health problems (77 and 55 %, respectively). In addition, family physicians were also consulted for general age-specific problems, such as genitourinary symptoms CONCLUSIONS In the first years after diagnosis of cancer in AYAs, both non-cancer specialist and family physician visits are common, although non-cancer specialist visits are less common and decline considerably faster than in younger children. IMPLICATIONS FOR CANCER SURVIVORS The specific pattern of physician visits of this age group calls for care that is tailored to their specific needs.
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Affiliation(s)
- Marianne J Heins
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500, BN, Utrecht, The Netherlands.
| | - Maria F Lorenzi
- BC Cancer Research Centre, BC Cancer Agency, 675 W10th Ave., Vancouver, BC, V5Z 1L3, Canada
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500, BN, Utrecht, The Netherlands
| | - Mary L McBride
- BC Cancer Research Centre, BC Cancer Agency, 675 W10th Ave., Vancouver, BC, V5Z 1L3, Canada
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26
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Guy GP, Yabroff KR, Ekwueme DU, Smith AW, Dowling EC, Rechis R, Nutt S, Richardson LC. Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff (Millwood) 2015; 33:1024-31. [PMID: 24889952 DOI: 10.1377/hlthaff.2013.1425] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescent and young adult cancer survivors-those who were ages 15-39 at their first cancer diagnosis-have important health limitations. These survivors are at risk for higher health care expenditures and lost productivity, compared to adults without a history of cancer. Using Medical Expenditure Panel Survey data, we present nationally representative estimates of the economic burden among people who were diagnosed with cancer in adolescence or young adulthood. Our findings demonstrate that surviving cancer at this age is associated with a substantial economic burden. Compared to adults without a history of cancer, adolescent and young adult cancer survivors had excess annual medical expenditures of $3,170 per person and excess annual productivity losses of $2,250 per person. Multifaceted prevention strategies, including education and sustained intervention programs to ensure access to lifelong risk-based follow-up care, may be effective ways to improve the economic outcomes associated with cancer survivorship in this population.
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Affiliation(s)
- Gery P Guy
- Gery P. Guy Jr. is a health economist in the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - K Robin Yabroff
- K. Robin Yabroff is an epidemiologist in the Division of Cancer Control and Population Sciences, National Cancer Institute (NCI), in Bethesda, Maryland
| | - Donatus U Ekwueme
- Donatus U. Ekwueme is a senior health economist in the Division of Cancer Prevention and Control, CDC
| | - Ashley Wilder Smith
- Ashley Wilder Smith is a behavioral scientist in the Division of Cancer Control and Population Sciences, NCI
| | - Emily C Dowling
- Emily C. Dowling is program manager for the Institute for Technology Assessment, Massachusetts General Hospital, in Boston, Massachusetts
| | - Ruth Rechis
- Ruth Rechis is vice president of Programs and Strategy at the LIVESTRONG Foundation, in Austin, Texas
| | - Stephanie Nutt
- Stephanie Nutt is a program manager on the Research and Evaluation Team, LIVESTRONG Foundation
| | - Lisa C Richardson
- Lisa C. Richardson is director of the Division of Blood Disorders, CDC
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27
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Kunin-Batson A, Steele J, Mertens A, Neglia JP. A randomized controlled pilot trial of a Web-based resource to improve cancer knowledge in adolescent and young adult survivors of childhood cancer. Psychooncology 2015; 25:1308-1316. [PMID: 26403252 DOI: 10.1002/pon.3956] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 06/11/2015] [Accepted: 08/05/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined cancer knowledge in adolescent and young adult (AYA) survivors and pilot tested a Web-based resource to provide individually tailored information regarding cancer treatment history, late effects risk, and resources. METHODS Fifty-two survivors (15-28 years old) who completed cancer treatment were recruited from the University of Minnesota oncology clinics. Participants were randomly assigned to receive access to personalized health history, late effects information, and resources via a password-protected Web portal or to standard of care (physician counseling) only. Participants completed surveys measuring cancer knowledge, health locus of control, and psychosocial well-being prior to randomization and approximately 1 year later. RESULTS Overall, few participants accurately reported their chemotherapy history with detail (19% at baseline and 33% at follow-up), and many did not recognize that previous cancer treatments could impact future health (60% at baseline and 54% at follow-up). Among those randomized to the receive access to the website, utilization was very low, making it difficult to draw conclusions about efficacy. Nonetheless, these data suggest that offering tailored information through the Web was not more effective than standard of care at improving cancer knowledge. Anxiety and health beliefs were associated with cancer knowledge, including knowledge of steps survivors could take to mitigate late effects risks (p < 01). CONCLUSIONS Knowledge gaps exist among AYA survivors regarding important aspects of their treatment histories and ongoing health risks. Offering purely educational information (either in person by providers or via the Web) does not appear to be enough to close this gap. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Alicia Kunin-Batson
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA. .,University of Minnesota Medical School, Minneapolis, MN, USA.
| | | | - Ann Mertens
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Joseph P Neglia
- University of Minnesota Medical School, Minneapolis, MN, USA
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28
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Patterson P, McDonald FEJ, Zebrack B, Medlow S. Emerging issues among adolescent and young adult cancer survivors. Semin Oncol Nurs 2014; 31:53-9. [PMID: 25636395 DOI: 10.1016/j.soncn.2014.11.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To review the characteristics of cancer in the adolescence and young adult age group; the medical, psychosocial and behavioral late effects; survivorship care planning and transition; current research priorities; and practice implications. DATA SOURCE Published articles, research studies and position statements. CONCLUSION Survivors of cancers that occurred during adolescence and young adulthood (AYA) are confronted with the dual demands of managing their transition to independent adulthood, concurrently with their transition from cancer patient to cancer survivors, with an associated reduction in support from medical services. AYA survivors also face complex medical, psychosocial and behavioral late effects, including fertility and mental health issues. IMPLICATIONS FOR NURSING PRACTICE An understanding of the impact of cancer diagnoses among this age group, including survivors' abilities to reintegrate into 'normal' life and potential long term consequences, is necessary to provide the best support. This care and support can be enhanced through multidisciplinary teams who work together to address the medical and psychosocial needs of AYAs diagnosed with cancer.
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29
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Barnett ME, Shuk EM, Conway FP, Ford JS. Cancer-Related Disclosure Among Adolescent and Young Adult Cancer Survivors: A Qualitative Study. J Adolesc Young Adult Oncol 2014; 3:123-129. [PMID: 25276496 PMCID: PMC4171114 DOI: 10.1089/jayao.2013.0043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) employ self-disclosure in normative social interactions and in promoting identity development. Disclosure is associated with numerous psychological and physical benefits. Little research has examined how AYA cancer survivors diagnosed during adolescence disclose their cancer history. Methods: Using a qualitative design, this study explored cancer-related disclosures among survivors (N=26) 16-24 years old at study (M=19.6 years), 14-18 years old at diagnosis (M=15.6 years), and currently at least 6 months post-treatment (M=3.2 years). Semi-structured interview guides were developed and used. Disclosure-related topics included survivorship communications and others' responses to AYAs' disclosure of their cancer experiences. Results: Grounded theory and thematic content analysis guided analyses, with an inductive data-driven approach. Three themes and eight subthemes emerged: "it depends" decision-making processes (don't ask/don't tell, shared experience, relationship potential), perceptions of others' responses (perceived apprehension, positive responses), and methods of disclosure (verbal, written, behavioral). No thematic differences were found by gender or age, although females reported greater frequency of disclosures. Conclusion: Disclosure emerged as a nuanced and complex process. "It depends" decision-making processes were most frequently endorsed, consistent with developmental complexities of this age group. This reflects social and psychological changes and highlights unique challenges for AYA survivors. This also reflects the importance of peers and social interactions as variables that influence disclosure. In the context of AYA cancer survivorship, understanding ways in which disclosure may bolster or hinder social support can assist survivors, clinicians, and families navigate survivorship. Implications for future research are discussed.
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Affiliation(s)
- Marie E. Barnett
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York
| | - Elyse M. Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Francine P. Conway
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, New York
| | - Jennifer S. Ford
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
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30
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Kirchhoff AC, Spraker-Perlman HL, McFadden M, Warner EL, Oeffinger KC, Wright J, Kinney AY. Sociodemographic Disparities in Quality of Life for Survivors of Adolescent and Young Adult Cancers in the Behavioral Risk Factor Surveillance System. J Adolesc Young Adult Oncol 2014; 3:66-74. [PMID: 24940530 DOI: 10.1089/jayao.2013.0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Survivors of cancer diagnosed during adolescence and young adulthood (AYA; aged 15-39) may experience quality of life (QOL) limitations; however, little is known about QOL for AYA survivors who are now middle-aged or among racial/ethnic minority survivors. We evaluated QOL outcomes for AYA cancer survivors relative to a non-cancer comparison group by gender, race/ethnicity, and current age. Methods: Using the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data, we identified 8375 individuals diagnosed with cancer while aged 15-39 years old and 334,759 controls. Participants were currently ≥20 years of age. QOL was measured using four items from the Center for Disease Control's Healthy Days Measure (general health, number of days of poor physical and mental health, and activity limitation days). Multivariable regressions compared these measures for survivors and controls by gender, race/ethnicity, and age, and among survivors to determine cancer-related factors associated with poor QOL. Results: Survivors were more likely to report fair/poor general health than controls (relative risk=1.92; 95% confidence interval: 1.77-2.10; p<0.001). QOL limitations existed by gender and race/ethnicity for survivors. Approximately 30% of survivors currently in their 40s, 50s, and early 60s were in poor health, compared to less than 20% of same-aged controls (both p<0.001). Of survivors with two or more cancers, 41.0% reported poor health, compared to 26.2% with one cancer (p<0.001). Conclusion: AYA cancer survivors have worse QOL compared to the general population and these limitations persist across gender, race/ethnicity, and age. Targeted interventions are essential for improving AYA cancer survivors' health status.
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Affiliation(s)
- Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute , Salt Lake City, Utah. ; Center for Children's Cancer Research, Huntsman Cancer Institute , Salt Lake City, Utah. ; Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Holly L Spraker-Perlman
- Center for Children's Cancer Research, Huntsman Cancer Institute , Salt Lake City, Utah. ; Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Molly McFadden
- Division of Epidemiology, Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Echo L Warner
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute , Salt Lake City, Utah
| | - Kevin C Oeffinger
- Departments of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - Jennifer Wright
- Center for Children's Cancer Research, Huntsman Cancer Institute , Salt Lake City, Utah. ; Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Internal Medicine and University of New Mexico Cancer Center, University of New Mexico , Albuquerque, New Mexico
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31
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Gorman JR, Roberts SC, Dominick SA, Malcarne VL, Dietz AC, Su HI. A Diversified Recruitment Approach Incorporating Social Media Leads to Research Participation Among Young Adult-Aged Female Cancer Survivors. J Adolesc Young Adult Oncol 2014; 3:59-65. [PMID: 24940529 DOI: 10.1089/jayao.2013.0031] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Cancer survivors in their adolescent and young adult (AYA) years are an understudied population, possibly in part because of the high effort required to recruit them into research studies. The aim of this paper is to describe the specific recruitment strategies used in four studies recruiting AYA-aged female cancer survivors and to identify the highest yielding approaches. We also discuss challenges and recommendations. Methods: We recruited AYA-aged female cancer survivors for two studies conducted locally and two conducted nationally. Recruitment strategies included outreach and referral via: healthcare providers and clinics; social media and the internet; community and word of mouth; and a national fertility information hotline. We calculated the yield of each recruitment approach for the local and national studies by comparing the number that participated to the number of potential participants. Results: We recruited a total of 534 participants into four research studies. Seventy-one percent were diagnosed as young adults and 61% were within 3 years of their cancer diagnosis. The highest-yielding local recruitment strategy was healthcare provider and clinic referral. Nationally, social media and internet outreach yielded the highest rate of participation. Overall, internet-based recruitment resulted in the highest number and yield of participants. Conclusion: Our results suggest that outreach through social media and the internet are effective approaches to recruiting AYA-aged female cancer survivors. Forging collaborative relationships with survivor advocacy groups' members and healthcare providers also proved beneficial.
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Affiliation(s)
- Jessica R Gorman
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| | - Samantha C Roberts
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| | - Sally A Dominick
- Moores Cancer Center, University of California , San Diego, La Jolla, California
| | - Vanessa L Malcarne
- Moores Cancer Center, University of California , San Diego, La Jolla, California. ; Department of Psychology, San Diego State University , San Diego, California
| | - Andrew C Dietz
- Department of Pediatrics, University of California , San Diego, La Jolla, California. ; Rady Children's Hospital-San Diego , San Diego, California
| | - H Irene Su
- Moores Cancer Center, University of California , San Diego, La Jolla, California
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32
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Kalmanti L, Saussele S, Lauseker M, Proetel U, Müller MC, Hanfstein B, Schreiber A, Fabarius A, Pfirrmann M, Schnittger S, Dengler J, Falge C, Kanz L, Neubauer A, Stegelmann F, Pfreundschuh M, Waller CF, Spiekermann K, Krause SW, Heim D, Nerl C, Hossfeld DK, Kolb HJ, Hochhaus A, Hasford J, Hehlmann R. Younger patients with chronic myeloid leukemia do well in spite of poor prognostic indicators: results from the randomized CML study IV. Ann Hematol 2013; 93:71-80. [PMID: 24162333 PMCID: PMC3889634 DOI: 10.1007/s00277-013-1937-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/09/2013] [Indexed: 01/31/2023]
Abstract
Since the advent of tyrosine kinase inhibitors, the impact of age on outcome of chronic myeloid leukemia (CML) patients has changed. We therefore analyzed patients from the randomized CML study IV to investigate disease manifestations and outcome in different age groups. One thousand five hundred twenty-four patients with BCR-ABL-positive chronic phase CML were divided into four age groups: (1) 16–29 years, n = 120; (2) 30–44 years, n = 383; (3) 45–59 years, n = 495; and (4) ≥60 years, n = 526. Group 1 (adolescents and young adults (AYAs)) presented with more aggressive disease features (larger spleen size, more frequent symptoms of organomegaly, higher white blood count, higher percentage of peripheral blasts and lower hemoglobin levels) than the other age groups. In addition, a higher rate of patients with BCR-ABL transcript levels >10 % on the international scale (IS) at 3 months was observed. After a median observation time of 67.5 months, no inferior survival and no differences in cytogenetic and molecular remissions or progression rates were observed. We conclude that AYAs show more aggressive features and poor prognostic indicators possibly indicating differences in disease biology. This, however, does not affect outcome.
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Affiliation(s)
- Lida Kalmanti
- III. Medizinische Klinik, Universitätsmedizin Mannheim, Pettenkoferstrasse 22, 68169, Mannheim, Germany
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Feuz C. Are Current Care Models Meeting the Psychosocial Needs of Adolescent and Young Adult Cancer Survivors? A Literature Review. J Med Imaging Radiat Sci 2013; 45:119-130. [PMID: 31051942 DOI: 10.1016/j.jmir.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adolescents and young adults diagnosed with cancer are expected to become long-term survivors. A cancer diagnosis during this critical life stage can have a profound impact on normal psychosocial development, increasing risk for adverse long-term and late effects and influencing quality of life. PURPOSE The purpose of this article was to review the impact of cancer on some key psychosocial aspects of adolescent and young adult cancer survivors, including the impact of a cancer diagnosis on psychosocial development, the effectiveness of current models of care in relation to addressing the psychosocial needs of this patient population, and the evaluation of current Canadian models of care and implications for clinical practice. METHODS A review of the English literature from 2002 to 2012 was performed using PubMed (National Center for Biotechnology Information), Ovid MEDLINE, and Google Scholar. RESULTS AND CONCLUSIONS Various survivorship care models have been implemented to assist adolescent and young adult cancer survivors in addressing the psychosocial issues associated with a cancer diagnosis, although the type of model used varies based on institutional resources and survivors' needs. Preliminary survivorship research identifies the need for long-term follow-up care including ongoing assessment for psychosocial issues. The literature also identifies the need to educate adolescents and young adults regarding their disease, which will empower these patients to act as their own health care advocates, resulting in improved health-related outcomes and overall quality of life. However, despite the increasing focus on the benefits of good survivorship care and the availability of government-funded survivorship programs in Canada, programs are often underused by this patient population. Survivorship care is a new focus for research that requires more evaluation regarding the feasibility and effectiveness of the different care models in meeting the psychosocial needs of adolescent and young adult cancer survivors.
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Affiliation(s)
- Carina Feuz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario Canada.
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Gondos A, Hiripi E, Holleczek B, Luttmann S, Eberle A, Brenner H. Survival among adolescents and young adults with cancer in Germany and the United States: an international comparison. Int J Cancer 2013; 133:2207-15. [PMID: 23616284 DOI: 10.1002/ijc.28231] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/11/2013] [Indexed: 01/22/2023]
Abstract
Serious concern arose in the scientific literature about the state of and progress in cancer survival among adolescent and young adult (AYA) patients in the recent years. We provide an up-to-date international comparison of survival among AYA patients. Using population-based cancer data from 11 German cancer registries and the SEER Program of the United States (covering populations of 39 and 33 million people, respectively), standardized tumor group classifications, period analysis and modeling, we compared the 5-year relative survival of AYA patients in the age groups 15-29 and 30-39 to survival seen among adults aged 40-49 for the 2002-2006 period. Additionally, we also provide an age-specific survival comparison between the two countries. In 2002-2006, for the overwhelming majority of the more than 30 types of cancer examined, AYA patients aged both 15-29 and 30-39 years had higher or similar survival than patients in the age group 40-49 in both countries. A numerically large and statistically significant survival deficit among AYA patients was only found for breast carcinomas in both populations, and colorectal and stomach carcinoma in the United States for the age group 15-29. Overall, results of the country-specific comparisons did not indicate systematic differences. With very few exceptions, no survival deficit between AYA patients and adults aged 40-49 years was found in either of the examined countries in the first decade of the 21st century.
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Affiliation(s)
- Adam Gondos
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
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35
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Geiger AM, Castellino SM, Tooze JA, Altschuler A, Month S, Mertens AC, Nekhlyudov L, Greene SM. Potential Role of Community-Based Healthcare System Data in Research on Survivors of Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2013; 2:53-58. [PMID: 23781401 DOI: 10.1089/jayao.2012.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We sought to examine issues of generalizability in research on adolescent and young adult (AYA) cancer survivorship that relies on using community-based healthcare delivery system data. METHODS Individuals aged 15 to 39 diagnosed with cancer between 1992 and 2006 were identified using data from community-based healthcare systems in California and Seattle. Loss to follow-up was defined as the first disenrollment (the end) of membership in the healthcare systems after cancer. Censoring occurred at death or study end (2009). We used Kaplan-Meier analysis to quantify follow-up, and multiple Cox regression to examine the association of follow-up loss with demographic and cancer characteristics. RESULTS Of 6828 eligible AYAs, most (93%) were aged between 20 and 39 years at diagnosis; 62% were female and 39% were non-White. Solid tumors accounted for 81% of diagnoses. The majority (89%) of patients continued to be members of the healthcare systems and available for follow-up 1 year after diagnosis. Approximately 60% remained enrolled 5 years after diagnosis. Loss to follow-up was associated with younger age at diagnosis, male gender, and African American or Hispanic race/ethnicity. CONCLUSION Data from community-based healthcare delivery systems offer an efficient way to identify large and diverse samples of AYA-onset cancer survivors. Differential loss to follow-up can threaten the generalizability of results from these studies and should be assessed quantitatively. Healthcare system data offer an alternative to studies requiring direct contact with participants.
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Affiliation(s)
- Ann M Geiger
- Division of Public Health Sciences, Wake Forest School of Medicine , Winston-Salem, North Carolina
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Kirchhoff AC, Lyles CR, Fluchel M, Wright J, Leisenring W. Limitations in health care access and utilization among long-term survivors of adolescent and young adult cancer. Cancer 2012; 118:5964-72. [PMID: 23007632 DOI: 10.1002/cncr.27537] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/02/2012] [Accepted: 02/21/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND Health care outcomes for long-term survivors of adolescent and young adult (AYA) cancer were compared with young adults without a cancer history, using the 2009 Behavioral Risk Factor Surveillance System data. METHODS Eligible participants were 20 to 39 years of age. There were N = 979 who self-reported a cancer diagnosis between the ages of 15 to 34 years and were at least 5 years from diagnosis (excluding nonmelanoma skin cancer). The remaining 67,216 participants with no cancer history were used as controls. Using multivariable regressions, relative risks and 95% confidence intervals were generated to examine the relationship of survivor status on indicators of poor health care (uninsured, no personal health care provider, no routine care, and avoiding seeing a doctor due to cost). Adjusted proportions were calculated by demographic groups. Results are weighted by Behavioral Risk Factor Surveillance System survey design. RESULTS Although the proportion uninsured did not differ (21% of survivors vs 23% of controls), AYA survivors reported forgoing care due to cost at higher levels than controls (relative risk = 1.67, 95% CI = 1.44-1.94). Cost barriers were particularly high for survivors aged 20 to 29 years (44% vs 16% of controls; P < .001) and female survivors (35% vs 18% of controls; P < .001). Survivors reporting poorer health had more cost barriers. Moreover, uninsured survivors tended to report lower use of health care than did controls. CONCLUSIONS AYA cancer survivors may forgo health care due to cost barriers, potentially inhibiting the early detection of late effects. Expanding health insurance coverage for young cancer survivors may be insufficient without adequate strategies to reduce their medical cost burdens.
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Affiliation(s)
- Anne C Kirchhoff
- Center for Children's Cancer Research, Huntsman Cancer Institute, Salt Lake City, Utah 84112, USA.
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Pemmaraju N, Kantarjian H, Shan J, Jabbour E, Quintas-Cardama A, Verstovsek S, Ravandi F, Wierda W, O'Brien S, Cortes J. Analysis of outcomes in adolescents and young adults with chronic myelogenous leukemia treated with upfront tyrosine kinase inhibitor therapy. Haematologica 2012; 97:1029-35. [PMID: 22271898 DOI: 10.3324/haematol.2011.056721] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Outcomes in chronic myeloid leukemia have improved with tyrosine kinase inhibitor treatment. However, little is known about outcomes of chronic myeloid leukemia in adolescent and young adult patients. DESIGN AND METHODS We reviewed all 468 chronic myeloid leukemia patients treated at our institution with tyrosine kinase inhibitors as initial therapy: imatinib (n=281), nilotinib (n=98) or dasatinib (n=89). RESULTS Median age was 47 years, median follow up 71 months and median treatment time with initial tyrosine kinase inhibitors 48 months. Adolescent and young adult was defined as aged 15-29 years. Sixty-one adolescent and young adult patients were identified. The only significant differences between adolescent and young adult and older patients were incidence of splenomegaly and distribution in Sokal risk groups. Only 3 adolescent and young adult patients have died. Rates of complete cytogenetic, major molecular and complete molecular response were significantly higher in older patients compared to adolescent and young adult patients, with a favorable trend in event-free survival for older patients. Transformation-free and overall survival were similar for the two groups. CONCLUSIONS The unfavorable trend in outcome for adolescent and young adult patients with chronic myeloid leukemia is unexpected. Additional research in this population is required to better define outcomes, understand the cause of this difference, and to help make better treatment recommendations.
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Affiliation(s)
- Naveen Pemmaraju
- Department of Leukemia, University of Texas, Anderson Cancer Center, Houston, TX 77230, USA
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