Romantic relationships of emerging adult survivors of childhood cancer

Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know

Sexual health may be disrupted in adolescents and young adults (AYAs) both during and after cancer treatment, irrespective of whether they are diagnosed in childhood, adolescence, or young adulthood. Unfortunately, oncology providers often underestimate the relevance of psychosexual issues for AYAs and underprioritize sexual health throughout treatment and survivorship. The purpose of this narrative review is to provide information on (a) the etiology of psychosexual dysfunction in childhood, adolescent, and young adult cancer patients and young adult survivors of childhood cancer; (b) strategies for communicating and evaluating potential sexual health issues of AYA patients/survivors; and (c) guidance for the practicing pediatric oncologist on how to address sexual health concerns with patients.

Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know

Sexual health may be disrupted in adolescents and young adults (AYAs) both during and after cancer treatment, irrespective of whether they are diagnosed in childhood, adolescence, or young adulthood. Unfortunately, oncology providers often underestimate the relevance of psychosexual issues for AYAs and underprioritize sexual health throughout treatment and survivorship. The purpose of this narrative review is to provide information on (a) the etiology of psychosexual dysfunction in childhood, adolescent, and young adult cancer patients and young adult survivors of childhood cancer; (b) strategies for communicating and evaluating potential sexual health issues of AYA patients/survivors; and (c) guidance for the practicing pediatric oncologist on how to address sexual health concerns with patients.

Sexual health among adolescent and young adult cancer survivors: A scoping review from the Children's Oncology Group Adolescent and Young Adult Oncology Discipline Committee

Sexual function is a vital aspect of quality of life among adolescent and young adult (AYA) (ages 15-39 years) cancer survivors. Sexual function encompasses physical, psychosocial, and developmental factors that contribute to sexual health, all of which may be negatively impacted by cancer and treatment. However, limited information is available to inform the care of AYA cancer survivors in this regard. This scoping review, conducted by the Children's Oncology Group AYA Oncology Discipline Committee, summarizes available literature regarding sexual function among AYA cancer survivors, including relevant psychosexual aspects of romantic relationships and body image. Results suggest that, overall, AYA cancer survivors experience a substantial burden of sexual dysfunction. Both physical and psychosocial sequelae influence survivors' sexual health. Interventions to support sexual health and psychosexual adjustment after cancer treatment are needed. Collaborations between the Children's Oncology Group and adult-focused cooperative groups within the National Cancer Institute's National Clinical Trials Network are warranted to advance prospective assessment of sexual dysfunction and test interventions to improve sexual health among AYA cancer survivors.

Romantic Relationships in Young People with Long-Term Health Conditions: A Scoping Review

OBJECTIVE

Forming and maintaining romantic relationships is an important developmental task in adolescence and young adulthood. This scoping review seeks to explore how young people with long-term physical health conditions understand and experience romantic relationships.

METHODS

Using Arksey and O'Malley's scoping review framework, a systematic search of five databases was conducted (PsychINFO, Cinahl, MEDLINE, Embase, and Web of Science). Studies were eligible for inclusion in the review if they were published in peer-reviewed journals, used primary data collection methods, and adopted quantitative, qualitative, or mixed-methods approaches to study romantic relationships in 11-25 year olds with long-term physical health conditions. Using a data extraction form, data pertaining to demographic characteristics of young people with long-term physical health conditions and relationship engagement were extracted from eligible papers.

RESULTS

Searches returned 4645 papers after duplicate removal, with a two-stage screening process resulting in 111 full-text papers being reviewed. Thirty-three eligible papers were included across a range of long-term physical health conditions. Findings identified that living with a long-term physical health condition impacted young people's perceptions and experiences of romantic relationships across the relationship lifespan, from envisaging future relationships, to forming relationships, and sustaining relationships. Issues around body confidence and self-esteem were identified as challenging in terms of perceptions and experiences of romantic relationships.

CONCLUSIONS

Findings demonstrate that young people wish to engage with romantic relationships, yet many report particular challenges associated with forming and sustaining relationships due to the constraints of their condition and treatment. Future research should consider nonheterosexual relationships.

Intimate partner violence and lower relationship quality are associated with faster biological aging

The characteristics of people's relationships have relevance to health-high quality romantic relationships are associated with improved health whereas intimate partner violence is associated with poorer health. Recently, increased attention has been focused on the biological processes underpinning these associations. A geroscience approach-examining whether close relationship characteristics are associated with biological aging-would complement previous research focused on individual disease pathways. This study used participants from the Dunedin Study (N = 974) to investigate relationship characteristics and biological aging across almost 20 years, from age 26 to 45. Being involved in romantic relationships was associated with slower biological aging, β = -0.12, p < .001. This difference represented 2.9 years of aging over the two decades. Greater relationship quality was also associated with slower biological aging, β = -0.19, p < .001, whereas higher levels of partner violence were associated with faster biological aging, β = 0.25, p < .001. A 1 SD difference in these characteristics was associated with a difference of 1.0 and 1.3 years of aging over the two decades, respectively. Secondary analyses suggested that experiencing violence from a partner was more strongly associated with biological aging than perpetrating violence, and that the experience of physical violence was more strongly associated with aging than psychological violence. These findings suggest that the characteristics of romantic relationships have relevance for biological aging in midlife. Interventions designed to increase relationship quality and decrease partner violence could reduce future morbidity and early mortality by slowing people's biological aging. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Fertility-Related Concerns and Uncertainties in Adolescent and Young Adult Childhood Cancer Survivors

Purpose: This study aimed to uncover the fertility-related concerns and uncertainties in adolescent and young adult (AYA) childhood cancer survivors. Methods: In this qualitative study, participants were recruited from an oncohematology outpatient clinic at a university hospital in Brazil. Twenty-four AYA cancer survivors, aged 18- 24 years (13 men and 11 women), participated in individual semistructured interviews focusing on two parts-sociodemographic and clinical variables and guiding questions that enabled understanding of the concerns and uncertainties regarding the risks of infertility and their impact on relationships and the need for guidance. Data were analyzed using inductive thematic analysis. Results: Four themes were identified from the data-(1) knowledge about fertility, (2) emotional impact and fertility-related uncertainty, (3) sharing the possible risk of infertility with partners, and (4) need for information on possible loss of fertility. Conclusion: The meanings attributed to the loss of fertility after cancer treatment uncovered the need for health professionals to organize survivor services in line with the survivors' needs, and include reproductive concerns and uncertainties in this planning. The study results provide insights for the development of health care services that meet the real needs of this particular population that has long-term follow-up demands.

"Family Is Who They Say They Are"a: Examining the Effects of Cancer on the Romantic Partners of Adolescents and Young Adults

In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.

Do single people want to date a cancer survivor? A vignette study

Objective

Qualitative studies indicated that cancer survivors may be worried about finding a partner in the future, but whether this concern is warranted is unknown. We examined single people´s interest in dating a cancer survivor, how they perceive survivors’ traits, and their preferences about the timing of disclosing a cancer history.

Methods

In three experimental vignette studies, dating website members (n = 324) and college students (n = 138 and n = 131) were randomly assigned to a vignette of a person with or without a history of cancer (experiment 1 & 2), or a cancer survivor beyond or during active follow-up (experiment 3). Respondents rated their interest in dating this fictive person, this person’s traits, and indicated their preferences about the timing of disclosure. ANOVAs with main and interaction effects of condition, gender, and relationship history were conducted, partial eta squared and Cohen’s d were used to estimate the magnitude of effects. Correlations were used to investigate relationships between interest in a date and assessment of traits.

Results

Cancer survivors’ traits were assessed more positively, but interest to date them did not differ from healthy vignettes for both men and women. However, widowed respondents were much less interested in a date with a cancer survivor, and women showed less interest in a cancer survivor during active follow-up relative to survivors beyond follow-up. Most respondents wanted to hear about the cancer diagnosis after a few dates, hardly anyone wanted to hear about this before the first date (2% - 5%).

Conclusion and implications for cancer survivors

Cancer survivors do not have to expect any more problems in finding a date than people without a cancer history, and can wait a few dates before disclosing. Survivors dating widowed people and survivors in active follow-up could expect more hesitant reactions and should disclose earlier.

The Experiences of Korean Young Adult Survivors of Childhood Cancer: A Photovoice Study

Photovoice was used to understand the impact of childhood cancer on Korean young adult survivors. Seven survivors of childhood cancer (currently aged 20-27 years), diagnosed before the age of 19 and with cancer treatment completed, participated in five sessions. The participants took photographs that captured their group's weekly topics and participated in discussions about their feelings and experiences. Fifty-six photo images with narratives on the survivors' experiences were produced on these four participant-selected themes: Relationships With Others, Stigma, Overcoming Difficulties, and The Future This study on Korean childhood cancer survivors sheds light on their perspectives about the impact of cancer. Using an innovative methodology that takes the participants' point of view, this study contributes to the literature on young adult cancer survivors' quality of life and their psychosocial adjustment. The results can inform educational programs and increase public awareness by providing survivors' schoolteachers and peers with knowledge about childhood cancer.

Erectile Dysfunction in Male Survivors of Childhood Cancer-A Report From the Childhood Cancer Survivor Study

INTRODUCTION

With survival rates higher than 80%, the number of survivors from pediatric cancer continues to increase. Late effects resulting from cancer and cancer therapy are being characterized, but little information exists on sexual health for men who have survived childhood cancer.

AIM

To assess erectile dysfunction (ED) in men who survived childhood and adolescent cancers and to identify potential risk factors for ED.

METHODS

In total, 1,622 men and 271 eligible brothers in the Childhood Cancer Survivor Study cohort completed the Male Health Questionnaire, which provided information on sexual practices and sexual function. Combined with demographic, cancer, and treatment information from medical record abstraction, results of the Male Health Questionnaire were analyzed using multivariable modeling. The International Index of Erectile Function was used to identify ED in subjects.

MAIN OUTCOME MEASURE

International Index of Erectile Function.

RESULTS

Survivors (mean age = 37.4 years, SD = 7.3 years) reported significantly lower sexual activity in the year before the survey than the brothers (mean age = 38.8 years, SD = 8.5 years) without cancer. ED was reported by 12.3% (95% CI = 10.4-14.3) of survivors and 4.2% (95% CI = 2.0-7.9) of brothers. Survivors showed significantly higher relative risk (RR) for ED (RR = 2.63, 95% CI = 1.40-4.97). In addition to older age, survivors who were exposed to higher-dose (≥10 Gy) testicular radiation (RR = 3.55, 95% CI = 1.53-8.24), had surgery on the spinal cord or nerves (RR = 2.87, 95% CI = 1.36-6.05), prostate surgery (RR = 6.56, 95% CI = 3.84-11.20), or pelvic surgery (RR = 2.28, 95% CI = 1.04-4.98) were at higher risk for ED.

CONCLUSION

Men who have survived childhood cancer have a greater than 2.6-fold increased risk for ED and certain cancer-specific treatments are associated with increased risk. Attention to sexual health, with its physical and emotional implications, and opportunities for early detection and intervention in these individuals could be important.

Psychosocial Late Effects in Pediatric Cancer Survivors: A Report From the Children's Oncology Group

BACKGROUND

This review was conducted to update the Children's Oncology Group (COG) Long-Term Follow-Up Guidelines (COG-LTFU Guidelines, version 4.0) regarding screening for psychosocial late effects of pediatric cancer.

PROCEDURE

Articles published between August 2009 and January 2011 that addressed psychosocial late effects of long-term survivors of pediatric cancer (n = 35) were reviewed by a multidisciplinary team of COG late effect experts.

RESULTS

The majority of studies in this time period indicate that survivors experience few psychosocial problems in long-term survivorship. A critical subset, however, is at increased risk for psychosocial late effects secondary to the treatment. Highlighted findings from this review include increased rates of suicidal ideation (SI), and health beliefs as robust predictors of SI, anxiety, and global distress. Survivors' health beliefs were associated with their perceptions of physical limitations, overall late effects, and cancer-related pain. While many survivorship studies continue to specify risk factors for anxiety and posttraumatic stress symptoms/posttraumatic stress disorder, others outcomes (e.g., developmental, interpersonal, and familial factors) appear to be emerging in importance.

CONCLUSIONS

Although the majority of childhood cancer survivors do not experience psychosocial problems, a subset will. The recent research findings have been included in the new COG-LTFU Guidelines that will assist in the targeted assessment and the treatment of survivors' psychosocial health.

Health Promoting Lifestyle Among Israeli Adult Survivors of Childhood Cancer

Background: Childhood cancer survivors are at risk for recurrence of their primary cancer as well as other secondary site cancers. The survivors are also at increased risk for long-term effects such as chronic illnesses. Health promoting lifestyles are therefore especially important for childhood cancer survivors. The purpose of the study was to describe the health promoting behaviors of childhood cancer survivors and to determine whether these behaviors are associated with demographic and clinical characteristics. This is a descriptive-comparative study that took place in an oncology follow-up clinic in Israel. Sample: Seventy-seven childhood cancer survivors. Tools: Health Promoting Lifestyle Profile 2, questionnaire (interpersonal relationships, spiritual growth, physical activity, nutrition, health responsibility, and stress management), and smoking and alcohol consumption and a demographic–clinical questionnaire. The mean item score was moderate-high. Survivors scored highest on interpersonal relationships and spiritual growth while the lowest scoring activities were physical activity and nutrition. About 30% of the survivors abstained from smoking and alcohol consumption. Women, as opposed to men, were more likely to have higher scores related to nutrition and interpersonal relationships while singles as opposed to those who were married were found to have higher scores related to spiritual growth. Conclusions: Health behaviors associated with interpersonal relationships and spiritual growth were more likely to be performed compared to physical activity, good nutrition, and decreased smoking and alcohol consumption. Special attention should be placed on promoting physical activity and good nutrition among survivors of childhood cancer.

The importance of assessing priorities of reproductive health concerns among adolescent and young adult patients with cancer

Visions for the future are a normal developmental process for adolescents and young adults (AYAs) with and without cancer, and these visions often include expectations of sexual and romantic relationships. AYA cancer survivors indicate reproductive health is an issue of great importance and more attention is needed in the health care setting throughout the cancer experience, beginning at diagnosis. Various practice guidelines are predominately focused on fertility; are intended to influence survivorship care plans; and do not encompass the broad scope of reproductive health that includes romantic partnering, friendships, body image, sexuality, sexual identity, fertility, contraception, and more. Although interventions to reduce reproductive health-related sequelae from treatment are best approached as an evolving process, practitioners are not certain of the priorities of these various reproductive health content areas. Strategies incongruent with the reproductive health priorities of AYAs will likely thwart adequate follow-up care and foster feelings of isolation from the treatment team. Research is needed to identify these priorities and ensure discussions of diverse content areas. This review explored various domains of reproductive health and emphasized how understanding the priorities of the AYA cancer cohort will guide future models of care.

[Life after childhood cancer: experiences of the survivors]

Late effects of cancer treatment in children, adolescents and young adults may be physical, social, and emotional, with effects on their quality of life. Through an ethnographic study, we sought to identify the impact on survivors' quality of life caused by late effects of treatment of childhood cancer. Twenty-one survivors participated in the study with aged between 10 and 29 years. Data were collected through interviews, observation, and clinical data from the medical charts. The data were analyzed around two themes: the experience of living with the late effects and life satisfaction. The experience revealed by children, adolescents and young adults, survivors of cancer, showed that they feel the impact of late effects in their lives. The intensity of these effects varied according to age groups, socio-cultural context, support health service and their families.

Talking About Cancer and Meeting Peer Survivors: Social Information Needs of Adolescents and Young Adults Diagnosed with Cancer

PURPOSE

Limited research exists on the social information needs of adolescents and young adults (AYAs, aged 15-39 at diagnosis) with cancer.

METHODS

The Adolescent and Young Adult Health Outcomes and Patient Experiences (AYA HOPE) Study recruited 523 patients to complete surveys 6-14 months after cancer diagnosis. Participants reported information needs for talking about their cancer experience with family and friends (TAC) and meeting peer survivors (MPS). Multiple logistic regression was used to examine factors associated with each need.

RESULTS

Approximately 25% (118/477) and 43% (199/462) of participants reported a TAC or MPS need respectively. Participants in their 20s (vs. teenagers) were more likely to report a MPS need (p=0.03). Hispanics (vs. non-Hispanic whites) were more likely to report a TAC need (p=0.01). Individuals who did not receive but reported needing support groups were about 4 and 13 times as likely to report TAC and MPS needs respectively (p<0.05). Participants reporting high symptom burden were more likely to report TAC and MPS needs (p<0.01), and those reporting fair/poor quality of care were more likely to report a TAC need (p<0.01). Those reporting that cancer had an impact on several key relationships with family and friends were more likely to report social information needs.

CONCLUSION

Social information needs are higher in AYAs diagnosed in their 20s, in Hispanics, among those reporting high symptom burden and/or lower quality of care, and in individuals not in support groups. Efforts should be made to develop interventions for AYAs in most need of social information and support.

Using a patient-centered approach to develop a fertility preservation brochure for pediatric oncology patients: a pilot study

STUDY OBJECTIVES

Most pediatric education materials are designed for a parent audience. Social marketing techniques rely on the principles called the "4 P's": product, price, place, and promotion. The objective of this study was to test the design, readability, likelihood to read, and overall opinion of a pediatric fertility preservation brochure with patients, parents, and providers.

DESIGN

Qualitative face-to-face interviews.

SETTING

The Children's Cancer Center in Tampa, FL, and All Children's Hospital in St. Petersburg, FL.

PARTICIPANTS

Male and female cancer patients and survivors aged 12-21 (N = 7), their parents (N = 11), and healthcare providers (N = 6).

INTERVENTIONS

Patients, survivors, parents, and healthcare providers were given two versions of gender concordant brochures on fertility preservation designed for both pediatric oncology patients and their parents.

OUTCOME MEASURES

Design, readability, likelihood to read, and overall opinion from interviews in order to identify facilitators of involving patients in fertility preservation discussions.

RESULTS

Parents and teens differed on the design, readability, and likelihood to read, the highest discord being preferences for medical terminology used in the brochures. While parents remarked that much of the language was 'too advanced,' the majority of teens explained that they understood the terminology and preferred it remained on the brochure. Overall feedback from all three groups was utilized to revise the brochures into final versions to increase the likelihood of reading.

CONCLUSION

Information about the development of the 4 P's of social marketing highlights needs from the intended audience. Barriers to patient education in pediatrics can be ameliorated when using the social marketing approach.

Using web-based and paper-based questionnaires for collecting data on fertility issues among female childhood cancer survivors: differences in response characteristics

BACKGROUND

Web-based questionnaires have become increasingly popular in health research. However, reported response rates vary and response bias may be introduced.

OBJECTIVE

The aim of this study was to evaluate whether sending a mixed invitation (paper-based together with Web-based questionnaire) rather than a Web-only invitation (Web-based questionnaire only) results in higher response and participation rates for female childhood cancer survivors filling out a questionnaire on fertility issues. In addition, differences in type of response and characteristics of the responders and nonresponders were investigated. Moreover, factors influencing preferences for either the Web- or paper-based version of the questionnaire were examined.

METHODS

This study is part of a nationwide study on reproductive function, ovarian reserve, and risk of premature menopause in female childhood cancer survivors. The Web-based version of the questionnaire was available for participants through the Internet by means of a personalized user name and password. Participants were randomly selected to receive either a mixed invitation (paper-based questionnaire together with log-in details for Web-based questionnaire, n = 137) or a Web-only invitation (log-in details only, n = 140). Furthermore, the latter group could request a paper-based version of the questionnaire by filling out a form.

RESULTS

Overall response rates were comparable in both randomization groups (83% mixed invitation group vs 89% in Web-only invitation group, P = .20). In addition, participation rates appeared not to differ (66% or 90/137, mixed invitation group vs 59% or 83/140, Web-only invitation group, P =.27). However, in the mixed invitation group, significantly more respondents filled out the paper-based questionnaire compared with the Web-only invitation group (83% or 75/90 and 65% or 54/83, respectively, P = .01). The 44 women who filled out the Web-based version of the questionnaire had a higher educational level than the 129 women who filled out the paper-based version (P = .01). Furthermore, the probability of filling out the Web-based questionnaire appeared to be greater for women who were allocated to the Web-only invitation group (OR = 2.85, 95% CI 1.31-6.21), were older (OR = 1.08, 95% CI 1.02-1.15), had a higher educational level (OR high vs low = 0.06, 95% CI 0.01-0.52), or were students (OR employed vs student = 3.25, 95% CI 1.00-10.56).

CONCLUSIONS

Although overall response as well as participation rates to both types of invitations were similar, adding a paper version of a questionnaire to a Web-only invitation resulted in more respondents filling out the paper-based version. In addition, women who were older, had a higher level of education, or were students, were more likely to have filled out the Web-based version of the questionnaire. Given the many advantages of Web-based over paper-based questionnaires, researchers should strongly consider using Web-based questionnaires, although possible response bias when using these types of questionnaires should be taken into account.

TRIAL REGISTRATION

Nederlands Trial Register NTR2922; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2922 (Archived by WebCite at http://www.webcitation.org/5zRRdMrDv).

Growing up with a chronic illness: social success, educational/vocational distress

OBJECTIVES

We compared adult educational, vocational, and social outcomes among young adults with and without childhood-onset chronic illness in a nationally representative U.S. sample.

METHODS

We used data from Wave IV (2008) of the National Longitudinal Study of Adolescent Health. We compared respondents who reported childhood-onset cancer, heart disease, diabetes, or epilepsy with young adults without these chronic illnesses in terms of marriage, having children, living with parents, romantic relationship quality, educational attainment, income, and employment. Multivariate models controlled for sociodemographic factors and adult-onset chronic illness.

RESULTS

As compared with those without childhood chronic illness, respondents with childhood chronic illness had similar odds of marriage (odds ratios [OR] = .89, 95% CI: .65-1.24), having children (OR = .99, 95% CI: .70-1.42), and living with parents (OR = 1.49, 95% CI .94-2.33), and similar reports of romantic relationship quality. However, the chronic illness group had lower odds of graduating college (OR = .49, 95% CI: .31-.78) and being employed (OR = .56, 95% CI: .39-.80), and higher odds of receiving public assistance (OR = 2.13, 95% CI: 1.39-3.25), and lower mean income.

CONCLUSIONS

Young adults growing up with chronic illness succeed socially, but are at increased risk of poorer educational and vocational outcomes.

Approaches to transition in other chronic illnesses and conditions

This article provides information about the efforts to develop health care transition programs in four groups of patients: those with cystic fibrosis, spina bifida, and congenital heart disease, and childhood cancer survivors. Against the backdrop of information on prevalence, data on long-term outcomes indicate the need for program development to improve these outcomes. The Life Course Model for spina bifida described throughout this issue of Pediatric Clinics of North America provides a model that anticipates and monitors progress toward adult outcomes that are desired for all youth with chronic conditions.

Dating relationships in college students with childhood-onset asthma

OBJECTIVE

The current study investigated whether differences existed in dating anxiety and fear of intimacy between individuals with childhood-onset asthma and individuals without a chronic illness. Analyses were also conducted to determine if dating anxiety or fear of intimacy were predictors of health-related quality of life in individuals with asthma and healthy controls. Additionally, potential gender differences in dating anxiety and fear of intimacy in individuals with childhood-onset asthma were explored.

METHODS

College undergraduates at least 17 years of age who self-identified as having childhood asthma were randomly matched by age and gender to healthy control participants. Participants completed a demographic form, the Dating Anxiety Scale for Adolescents, the Fear of Intimacy Scale, and the SF-36 Health Survey, a measure of health-related quality of life.

RESULTS

There were no significant differences between self-identified participants with asthma and matched healthy controls on the Dating Anxiety Scale or Fear of Intimacy Scale. However, dating anxiety was a significant predictor of mental health-related quality of life in participants with asthma but not in matched health controls. Fear of intimacy was not a significant predictor of mental or physical health-related quality of life in individuals with asthma. In addition, women with asthma endorsed significantly more dating anxiety and lower physical health-related quality of life than males with asthma.

CONCLUSION

College students with asthma appear to experience similar levels of dating anxiety and fear of intimacy than healthy college students; however, their anxiety about dating may have a larger effect on health-related quality of life than healthy individuals. Additional examination of dating and interpersonal relationships among individuals with asthma appears warranted, particularly as it concerns possible gender differences in individuals with childhood-onset asthma.