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Hernádfői MV, Koch DK, Kói T, Imrei M, Nagy R, Máté V, Garai R, Donnet J, Balogh J, Kovács GT, Párniczky A, Hegyi P, Garami M. Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024; 178:548-566. [PMID: 38619829 PMCID: PMC11019450 DOI: 10.1001/jamapediatrics.2024.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024]
Abstract
Importance Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer. Objective To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers. Data Sources A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023. Study Selection Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors. Data Extraction and Synthesis Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model. Results The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls. Conclusion and Relevance Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.
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Affiliation(s)
- Márk Viktor Hernádfői
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Bethesda Children’s Hospital, Budapest, Hungary
| | - Dóra Kornélia Koch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Vanda Máté
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Réka Garai
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Jessica Donnet
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - József Balogh
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Andrea Párniczky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Miklós Garami
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Pediatric Center, Semmelweis University, Budapest, Hungary
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Frederick NN, Lehmann V, Ahler A, Carpenter K, Cherven B, Klosky JL, Nahata L, Quinn GP. Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know. Pediatr Blood Cancer 2023; 70 Suppl 5:e30611. [PMID: 37548483 DOI: 10.1002/pbc.30611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 08/08/2023]
Abstract
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.
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Affiliation(s)
- Natasha N Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), Department of Sexual Medicine, University of Basel, Basel, Switzerland
| | - Kristen Carpenter
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Brooke Cherven
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
| | - James L Klosky
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
| | - Leena Nahata
- Department of Pediatrics, Endocrinology and Center for Biobehavioral Health, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Gwendolyn P Quinn
- Departments of OB-GYN, Population Health, Center for Medical Ethics, School of Medicine, New York University, New York, New York
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Oh S, Lee H, Kim S, Kim S, Lyu CJ, Park CG, Kang HJ. Development and psychometric properties of the social adjustment scale for youth cancer survivors in South Korea. Asia Pac J Oncol Nurs 2023; 10:100241. [PMID: 37435599 PMCID: PMC10331412 DOI: 10.1016/j.apjon.2023.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/04/2023] [Indexed: 07/13/2023] Open
Abstract
Objective We developed a new scale-the Social Adjustment Scale for Youth Cancer Survivors-and examined its psychometric properties. Methods In the scale's development stage, preliminary items were constructed based on the results of a concept analysis of the hybrid model, literature review, and interviews. These items were then reviewed through content validity and cognitive interviews. In the validation stage, 136 survivors were recruited from two children's cancer centers in Seoul, South Korea. An exploratory factor analysis was performed to identify a set of constructs, and validity and reliability were tested. Results Starting with 70 items constructed through literature review and interviews with youth survivors, the final scale comprised 32 items. The exploratory factor analysis identified four domains-namely, role achievement in one's present position, harmony in relationships, disclosure and acceptance of cancer history, and preparation and expectation for future roles. Correlations with quality of life indicated good convergent validity (r = 0.82, P < 0.001). The Cronbach's α of the overall scale was 0.95, indicating excellent internal consistency; and the intraclass correlation coefficient was 0.94 (P < 0.001), suggesting high test-retest reliability. Conclusions The Social Adjustment Scale for Youth Cancer Survivors exhibited acceptable psychometric properties in measuring the social adjustment of youth cancer survivors. It can be used to identify youths facing difficulty in adjusting to society after treatment and to investigate the effect of interventions implemented to promote social adjustment among youth cancer survivors. Future research is needed to examine the applicability of the scale in patients across diverse cultural backgrounds and healthcare systems.
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Affiliation(s)
- Sumi Oh
- College of Nursing, Health and Nursing Research Institute, Jeju National University, Jeju Special Self-Governing Province, South Korea
| | - Hyejung Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Sue Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Sanghee Kim
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hemato-oncology, Yonsei University Health System, College of Medicine, Yonsei University, Seoul, South Korea
| | - Chang Gi Park
- Department of Population Health Nursing Science, College of Nursing, University of Illinois, Chicago, USA
| | - Hyoung Jin Kang
- Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
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Milner S, Feltbower RG, Absolom K, Glaser A. Identifying the important social outcomes for childhood cancer survivors: an e-Delphi study protocol. BMJ Open 2022; 12:e063172. [PMID: 36410830 PMCID: PMC9680166 DOI: 10.1136/bmjopen-2022-063172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Optimising the health of childhood cancer survivors is important given the high long-term survival rate coupled with a significant late effects burden. Included within the WHO's definition of 'Health' are social outcomes. These are of interest given their impact on adult functioning within society, complex interactions with physical and mental health outcomes and potential for cross generational effects. Categories included within the definition of social outcomes are ill defined leading to potential gaps in research and service provision which could affect the ability of survivors to achieve their maximal potential. An e-Delphi study will be used to achieve expert consensus on the most important social outcomes for childhood cancer survivors to inform future research and ultimately, service provision. METHODS AND ANALYSIS A heterogeneous sample of at least 48 panel members will be recruited across four groups chosen to provide different perspectives on the childhood cancer journey: childhood cancer survivors, health professionals, social workers and teachers. Purposive sampling from a UK, regional long-term follow-up clinic will be used to recruit a representative sample of survivors. Other panel members will be recruited through local channels and national professional working groups. Opinions regarding breakdown and relevance of categories of social outcome will be collected through 3-5 rounds of questionnaires using an e-Delphi technique. Open ended, 7-point Likert scale and ranking questions will be used. Each round will be analysed collectively and per group to assess inter-rater agreement. Agreement and strength of agreement will be indicated by a median score of 6 or 7 and mean absolute deviation from the median, respectively. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by Regional Ethics Committee 4, West of Scotland (ID 297344). Study findings will be disseminated to involved stakeholders, published in a peer-reviewed journal and presented at conferences.
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Affiliation(s)
- Sarah Milner
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - Adam Glaser
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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5
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Maurice-Stam H, van Erp LME, Maas A, van Oers HA, Kremer LCM, van Dulmen-den Broeder E, Tissing WJE, Loonen JJ, van der Pal HJH, Beek LR, de Vries ACH, van den Heuvel-Eibrink MM, Ronckers CM, Bresters D, Louwerens M, van der Heiden-van der Loo M, Huizinga GA, Grootenhuis MA. Psychosocial developmental milestones of young adult survivors of childhood cancer. Support Care Cancer 2022; 30:6839-6849. [PMID: 35538326 PMCID: PMC9213344 DOI: 10.1007/s00520-022-07113-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Purpose The study aimed to compare the psychosocial development of young adult survivors of childhood cancer (YACCS) with a norm group of young adults from the general population. Methods From 2017 to 2020, 558 YACCS (18–30 years, 51% female, 10.9% CNS cancer) who participated in the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort (diagnosed 1963–2001) part 2 completed the Course of Life Questionnaire (CoLQ), assessing the achievement of milestones. Items were grouped into the scales autonomy, psychosexual, and social development. Differences between YACCS and norm group were examined with ANOVA and Cohen’s d (CoLQ scales) and with logistic regression analysis and odds ratio (OR) (CoLQ items), for the total group and YACCS of CNS cancer. Results The total group of YACCS did not report a less favorable psychosocial development than the norm group. YACCS of CNS cancer scored lower than the norm group (p < 0.001) on the scales autonomy (d = − 0.36) and psychosexual (d = − 0.46). Additionally, on half of the items of autonomy (0.25 ≤ OR ≤ 0.34), psychosexual (0.30 ≤ OR ≤ 0.48), and social (0.23 ≤ OR ≤ 0.47) development, YACCS of CNS cancer were less likely (p < 0.01) than the norm group to have achieved the milestones. Conclusion Overall, psychosocial development of YACCS was as favorable as the norm, but YACCS of CNS cancer were at risk of an unfavorable psychosocial development in all domains. Monitoring psychosocial development should be included in the standards of psychosocial care, especially for CNS cancer patients and survivors, to be able to trace delay. Personalized interventions should be offered to improve the psychosocial development in an early stage.
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Affiliation(s)
- Heleen Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
| | - Loes M E van Erp
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Anne Maas
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Hedy A van Oers
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam Reproduction and Development, Amsterdam Public Health, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | | | - Helena J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Laura R Beek
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Andrica C H de Vries
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Willem Alexander Children's Hospital/Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gea A Huizinga
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, The Netherlands
| | - Martha A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
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Efe YS, Özbey H, Caner N, Erdem E, Kuzucu EG, Karakükçü M, Patıroğlu T, Ünal E, Yılmaz E, Özcan A. Social exclusion and behavior problems in adolescents with cancer and healthy counterparts. J Pediatr Nurs 2022; 64:e95-e101. [PMID: 34998654 DOI: 10.1016/j.pedn.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This cross-sectional study was conducted to determine social exclusion, internalized and externalized behavioral problems in adolescents with cancer and to compare them with healthy counterparts. DESIGN AND METHODS The sample consisted of adolescents age 10-19 years (N = 70) followed up in the hemato-oncology outpatient clinic of a tertiary hospital and healthy adolescents age 10-19 years (N = 92) who were studying in secondary and high schools. The data were collected with a questionnaire for adolescents with cancer and healthy adolescents, The Ostracism Experience Scale for Adolescents (OES-A), Youth Externalizing Behavior Screener (YEBS), and Youth Internalizing Problems Screener (YIPS). RESULTS The OES-A mean scores of cancer and healthy adolescents in the study were 35.68 ± 9.38 and 27.64 ± 5.35 (p ≤ 0.001), the YEBS mean scores were 23.51 ± 4.88 and 20.52 ± 5.42 (p ≤ 0.001), and the YIPS mean scores were 21.72 ± 6.48 and 19.18 ± 7.60 (p = 0.007), respectively. There was a low-level positive correlation between the mean scores of the OES-A and YEBS (r = 0.345, p < 0.05) and mean scores of the YEBS and YIPS (r = 0.308, p < 0.05) of adolescents with cancer. CONCLUSIONS Adolescents with cancer had higher scores on social exclusion, internalized and externalized behavioral problems than healthy counterparts in the current study. PRACTICE IMPLICATIONS The current study should lead pediatric oncology nurses to be more aware of social exclusion and internalized and externalized behavioral problems in adolescents with cancer after clinical treatment, and to provide appropriate psycho-oncological care.
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Affiliation(s)
- Yağmur Sezer Efe
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Harun Özbey
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Nuray Caner
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Emine Erdem
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | | | - Musa Karakükçü
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Türkan Patıroğlu
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Ekrem Ünal
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ebru Yılmaz
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Alper Özcan
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Hendriks MJ, Hartmann N, Harju E, Roser K, Michel G. "I don't take for granted that I am doing well today": a mixed methods study on well-being, impact of cancer, and supportive needs in long-term childhood cancer survivors. Qual Life Res 2022; 31:1483-1497. [PMID: 34820777 PMCID: PMC9023419 DOI: 10.1007/s11136-021-03042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE With increasing numbers of childhood cancer survivors (CCS), it is important to identify the impact of cancer and CCS' needs for support services that can mitigate the long-term impact on psychosocial wellbeing, including health-related quality of life (HRQOL). We aimed (1) to describe survivors' wellbeing, impact of cancer, and supportive care needs and (2) to determine how socio-demographic or clinical characteristics and impact of cancer relate to survivors' unmet needs. METHOD In this mixed methods study, a quantitative survey was used to assess HRQOL, psychological distress, impact of cancer, and supportive care needs. Qualitative interviews were conducted to explore the meaning of wellbeing, health, and impact of cancer. RESULTS Overall, 69 CCS participated in the survey of which 28 participated in qualitative interviews (aged ≥ 18 years, diagnosed with cancer ≤ 18 years). Few CCS (13%) reported poor physical HRQOL, but almost half reported poor mental HRQOL (49%) and psychological distress (42%). Health was considered to encompass both: physical and emotional aspects of wellbeing. Cancer positively impacted CCS' ability to care and attitude towards life, whereas relationships and insurance were negatively impacted. Risks for unmet needs increased in CCS with self-reported low health status, late effects, psychological distress, with older age at study or longer time since end of treatment. CONCLUSION In our study, many CCS experienced various psychosocial, psychological and informational unmet needs, indicating that survivors' needs are currently not duly addressed. Current efforts to provide supportive psychosocial care in Switzerland should be further operationalized to provide adequate support.
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Affiliation(s)
- Manya Jerina Hendriks
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
- Department of Neonatology, Clinical Ethics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nathalie Hartmann
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.
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8
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Support needs of Dutch young adult childhood cancer survivors. Support Care Cancer 2022; 30:3291-3302. [PMID: 34981198 PMCID: PMC8723798 DOI: 10.1007/s00520-021-06723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Studies about support needs of young adult childhood cancer survivors (YACCS) previously focused mainly on information needs. This study assessed support needs and associated factors (sociodemographic, medical, and psychosocial functioning) in Dutch YACCS. METHODS YACCS (aged 18-30, diagnosed ≤ 18 years, time since diagnosis ≥ 5 years) cross-sectionally filled out a questionnaire regarding their need for various types of support (concrete information, personal counseling, and peer contact) in eight domains (physical consequences of childhood cancer, social-emotional consequences, relationships and sexuality, fertility, lifestyle, school and work, future perspective, insurance and mortgage), and questionnaires assessing health-related quality of life (PedsQL-YA), anxiety and depression (HADS), and fatigue (CIS-20R). Descriptive statistics were used to describe support needs. Linear regression was used to identify characteristics associated with support needs. RESULTS One hundred fifty-one YACCS participated (response = 40%). Most YACCS reported a need for support in one or more domains (88.0%, N = 133). More than half of the participants reported a need for concrete information in the domains lifestyle, fertility, and physical consequences of childhood cancer and 25-50% in the domains insurance and mortgages, future perspective, and social-emotional consequences of childhood cancer. In the domains lifestyle and physical as well as emotional consequences of childhood cancer, 25-50% reported a need for counseling. Overall need for support was positively associated with middle (β = 0.26, p = 0.024) and high (β = 0.35, p = 0.014) compared to low educational attainment and (sub)clinical anxiety (β = 0.22, p = 0.017), and negatively associated with social functioning (β = - 0.37, p = 0.002) in multivariate analyses. CONCLUSION YACCS report the strongest need for support, for concrete information, in the domains lifestyle, fertility, and physical consequences of childhood cancer. Associated factors were mostly socioeconomic and psychosocial in nature. Psychosocial care should be an integral part of survivorship care for YACCS, with screening for psychosocial problems, information provision including associated emotional consequences and support if necessary (psycho-education) and tailored interventions, and adequate referrals to more specialized care if necessary.
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9
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Frederick NN, Lehmann V, Ahler A, Carpenter K, Cherven B, Klosky JL, Nahata L, Quinn GP. Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know. Pediatr Blood Cancer 2021:e28437. [PMID: 34873822 PMCID: PMC9167888 DOI: 10.1002/pbc.28437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Natasha N. Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, University of Connecticut School of Medicine
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), Department of Sexual Medicine, University of Basel
| | - Kristen Carpenter
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH
| | - Brooke Cherven
- Department of Pediatrics, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - James L. Klosky
- Department of Pediatrics, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Endocrinology and Center for Biobehavioral Health, Nationwide Children’s Hospital
| | - Gwendolyn P. Quinn
- Departments of OB-GYN, Population Health, Center for Medical Ethics, School of Medicine, New York University
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10
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Bashore L, Hobbie W. Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care. Semin Oncol Nurs 2021; 37:151163. [PMID: 34144848 DOI: 10.1016/j.soncn.2021.151163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families. DATA SOURCES Research and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used. CONCLUSION Many challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health. IMPLICATIONS FOR NURSING PRACTICE Pediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.
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Affiliation(s)
| | - Wendy Hobbie
- Children's Hospital of Philadelphia, Philadelphia, PA
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11
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van Erp LME, Maurice-Stam H, Kremer LCM, Tissing WJE, van der Pal HJH, de Vries ACH, van den Heuvel-Eibrink MM, Versluys BAB, Loonen JJ, Bresters D, Louwerens M, van der Heiden-van der Loo M, van den Berg MH, Ronckers CM, van der Kooi ALLF, van Gorp M, van Dulmen-den Broeder E, Grootenhuis MA. Health-related quality of life in Dutch adult survivors of childhood cancer: A nation-wide cohort study. Eur J Cancer 2021; 152:204-214. [PMID: 34119924 DOI: 10.1016/j.ejca.2021.04.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate the health-related quality of life (HRQOL) of Dutch adult childhood cancer survivors (CCS) and to identify risk factors of impaired HRQOL. METHODS Adult CCS (age >18, diagnosed <18, ≥5 years since diagnosis) from the Dutch LATER registry completed the Medical Outcome Study Short Form 36 (SF-36) to measure HRQOL and provided sociodemographic characteristics. Age-adjusted mean SF-36 scale scores of CCS were compared to the Dutch general population for men and women separately using t-tests, with effect size d. Multivariate logistic regression models were built to identify sociodemographic and cancer-related risk factors for impaired physical and mental HRQOL. RESULTS Both male and female CCS (N = 2301, mean age = 35.4 years, 49.6% female) reported significantly (p ≤ .005) worse HRQOL than the general population on almost all scales of the SF-36 (-.11 ≤ d ≤ -.56). Largest differences were found on vitality and general health perceptions. Significant risk factors (p ≤ .05) for impaired physical HRQOL were female sex, older age at diagnosis, not having a partner, low educational attainment, disease recurrence and exposure to radiotherapy, specifically to lower extremity radiation. Odds ratios (ORs) ranged from 1.6 to 3.7. Significant risk factors for impaired mental HRQOL were age 26-35 years, male sex, not having a partner and low educational attainment. ORs ranged from 1.3 to 2.0. CONCLUSION Adult CCS had worse HRQOL than the general population. CCS most at risk were those with low educational attainment and without a partner. Adult CCS could benefit from routine surveillance of their HRQOL. Special attention for CCS' vitality and health perceptions and beliefs is warranted.
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Affiliation(s)
- L M E van Erp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - H Maurice-Stam
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - L C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Beatrix Children's Hospital/University of Groningen/University Medical Center Groningen, Groningen, the Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - A C H de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Sophia Children's Hospital/Erasmus Medical Center, Rotterdam, the Netherlands
| | - B A B Versluys
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J Loonen
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - D Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - M Louwerens
- Leiden University Medical Center, Leiden, the Netherlands
| | | | - M H van den Berg
- Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Paediatrics, Amsterdam, the Netherlands
| | - C M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Brandenburg Medical School, Institute of Biostatistics and Registry Research, Neuruppin, Germany
| | - A L L F van der Kooi
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Erasmus MC, University Medical Centre, Rotterdam, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
| | - M van Gorp
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - E van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Amsterdam UMC/location VUmc, Amsterdam, the Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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12
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Hendriks MJ, Harju E, Roser K, Ienca M, Michel G. The long shadow of childhood cancer: a qualitative study on insurance hardship among survivors of childhood cancer. BMC Health Serv Res 2021; 21:503. [PMID: 34034742 PMCID: PMC8152348 DOI: 10.1186/s12913-021-06543-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term consequences of childhood cancer have received increasing attention due to the growing number of survivors over the past decades. However, insurance hardships of survivors are mostly unknown. This study explored qualitatively, in a sample of childhood cancer survivors (CCS), (i) the experiences and needs of CCS living in Switzerland with a special focus on hardships related to insurance; and (ii) the views of insurance and law experts with experience on childhood cancer. METHODS Semi-structured interviews were conducted with 28 childhood cancer survivors and 3 experts (one legal expert, two insurance experts). Data was analysed using qualitative content analysis. RESULTS Three key themes emerged from the interviews with the CCS: 1) experiences with insurance, 2) perception of discrimination, and 3) needs and barriers for support. The interviewed experts provided further detailed clarification of CCS' concerns. Our findings indicated that some CCS can move past their cancer history, while others continue to face hardships. CCS reported confusion about the opportunities and services within the social security system and most relied on their personal contacts for guidance. Finally, CCS expressed a strong need for socio-economic and legal support for social insurance questions, especially related to disability insurance. CONCLUSIONS With the growing population of CCS, it is essential to further assess the interplay between medical and psychosocial health and socio-economic hardship. Supportive psychosocial services should aim to ameliorate insurance hardships. Better understanding of the relationship between childhood cancer and insurance hardships during survivorship will inform efforts to improve long-term financial security and health outcomes for survivors. We call for the public, lawmakers, researchers, insurers, and patient organizations to come together and discuss future perspectives to avoid the risk of discrimination for cancer survivors.
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Affiliation(s)
- Manya Jerina Hendriks
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.,Clinical Ethics, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Marcello Ienca
- Department of Health Science and Technology, Technical University of Zurich, Zurich, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.
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13
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A roadmap of six different pathways to improve survival in laryngeal cancer patients. Curr Opin Otolaryngol Head Neck Surg 2021; 29:65-78. [PMID: 33337612 DOI: 10.1097/moo.0000000000000684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence 'more evidence-based' selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view. RECENT FINDINGS This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered 'big data' and their integration into approaches for the optimization of prevention and treatments strategies. SUMMARY Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results.
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14
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Desjardins L, Lai MC, Vorstman J, Bartels U, Barrera M. A Novel Approach to Understanding Social Behaviors in Pediatric Brain Tumor Survivors: A Pilot Study. J Pediatr Psychol 2021; 46:80-90. [PMID: 33377489 DOI: 10.1093/jpepsy/jsaa090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Pediatric brain tumor survivors (PBTS) are at risk of experiencing challenges in social adjustment. However, the specific social behaviors of PBTS have rarely been directly assessed. This pilot study explores the first novel use of the Autism Diagnostic Observation Schedule, second edition (ADOS-2), to evaluate the social behaviors of PBTS. METHODS Twenty-six PBTS (ages 9-17 years; M = 7.8 years from diagnosis; 52% male; 41% received radiation treatment) completed the ADOS-2. The proportion of the sample experiencing impairment was examined descriptively across all items of the ADOS-2, as well as by a summary "overall score" created for this study, and using the ADOS-2 "diagnostic algorithm" scores for autism. Social adjustment, cognitive, medical, and demographic variables were explored as correlates of the ADOS-2 "overall score". RESULTS Study recruitment was 34%, impeded by distance from the tertiary-care center. The percentage of PBTS experiencing detectable impairments ranged from 0% to 50% across ADOS-2 items. Cranial radiation treatment, lower IQ, and slower cognitive processing were associated with higher impairment on the ADOS-2 "overall score". CONCLUSION The ADOS-2 can be used to assess the discrete social behaviors of PBTS. This study provides a foundation for future investigations using the ADOS-2 to assess social behaviors in this population. Identifying specific social behavior difficulties in PBTS is key to refining much needed targeted social skills interventions for this population.
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Affiliation(s)
- Leandra Desjardins
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Charles-Bruneau Cancer Care Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Azrieli Adult Neurodevelopmental Centre, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jacob Vorstman
- Department of Psychiatry and Autism Research Unit, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Ontario Institute of Studies in Education and Institute of Medical Sciences, University of Toronto, Toronto, Canada
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15
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Schulte F, Forbes C, Wurz A, Patton M, Russell KB, Pluijm S, Krull KR. Childhood Cancer Survivorship: Daily Challenges. Pediatr Clin North Am 2020; 67:1083-1101. [PMID: 33131536 DOI: 10.1016/j.pcl.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Survivors of childhood cancer are at risk of experiencing fatigue, pain, lower levels of physical activity, increased engagement in risky health behavior, and poor social adjustment, after finishing treatment. Risks are more pronounced for survivors of specific diagnoses or receiving specific treatment protocols. Interventions to address these outcomes are in their infancy. Future research should focus on exploring the antecedents and consequences of these outcomes. In the meantime, researchers and cancer centers should attempt to provide high-quality and accessible health information to survivors through various media outlets to encourage healthy behaviors.
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Affiliation(s)
- Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
| | - Caitlin Forbes
- University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amanda Wurz
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Saskia Pluijm
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, TN, USA
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16
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Desjardins L, Rodriguez E, Dunn M, Bemis H, Murphy L, Manring S, Winning A, Vannatta K, Gerhardt CA, Compas BE. Coping and Social Adjustment in Pediatric Oncology: From Diagnosis to 12 Months. J Pediatr Psychol 2020; 45:1199-1207. [PMID: 32930722 DOI: 10.1093/jpepsy/jsaa077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Children diagnosed with cancer experience stress associated with their diagnosis and treatment and are at heightened risk for problems in social adjustment. This study investigated the association between coping with cancer-related stress and problems in social adjustment across the first year after a pediatric cancer diagnosis. METHODS Mothers of children (ages 5-17 years) with cancer (N = 312) were recruited from two children's hospitals. Mother's reported on their child's social adjustment and coping near diagnosis (T1) and 12 months (T2). RESULTS Primary, secondary control, and disengagement coping were significantly associated with concurrent social adjustment at 12 months. The bivariate associations between baseline primary and secondary control coping and social problems 12 months later were no longer significant in a multivariate regression model. CONCLUSIONS These findings inform our understanding of the association between coping with cancer-related stress and social adjustment of children diagnosed with cancer. Interventions teaching primary and secondary control coping strategies for cancer-related stressors may offer some benefit to concurrent youth social adjustment. Further research is needed on how best to support social adjustment in this population over time.
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Affiliation(s)
| | | | | | | | | | | | - Adrien Winning
- The Research Institute at Nationwide Children's Hospital
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
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17
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Chow EJ, Ness KK, Armstrong GT, Bhakta N, Yeh JM, Bhatia S, Landier W, Constine LS, Hudson MM, Nathan PC. Current and coming challenges in the management of the survivorship population. Semin Oncol 2020; 47:23-39. [PMID: 32197774 PMCID: PMC7227387 DOI: 10.1053/j.seminoncol.2020.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
With the widespread adoption of multimodality treatment, 5-year survival of children diagnosed with cancer has improved dramatically in the past several decades from approximately 60% in 1970 to greater than 85% currently. As a result, there are an estimated nearly half a million long-term survivors of childhood cancer living in the United States today. However, survivors have, on average, significantly greater serious medical and psychosocial late effects compared with the general population. In this review, we will discuss the current epidemiology of childhood cancer survivorship, including new methods to estimate the burden of late effects and genetic susceptibility toward late effects. We will also review the development of surveillance guidelines for childhood cancer survivors and early toxicity signals from novel agents now being tested and used increasingly to treat pediatric and adult cancers. We conclude with an overview of current models of survivorship care and areas for future research.
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Affiliation(s)
- Eric J Chow
- Division of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer M Yeh
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Social attainment in survivors of pediatric central nervous system tumors: a systematic review and meta-analysis from the Children's Oncology Group. J Cancer Surviv 2019; 13:921-931. [PMID: 31625086 DOI: 10.1007/s11764-019-00808-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Improved therapies for pediatric central nervous system (CNS) tumors have increased survival rates; however, many survivors experience significant long-term functional limitations. Survivors of pediatric CNS tumors can experience deficits in social attainment. The aim of this review was to systematically amalgamate findings pertaining to social attainment (i.e., educational attainment, marriage, employment outcomes) in survivors of pediatric CNS tumors. METHODS PubMed (web-based), PsycINFO (EBSCO), EMBASE (Ovid), and Web of Science (Thomson Reuters) were used to identify articles published between January 2011 and September 2018. Eligible studies reported outcomes for survivors of pediatric CNS tumors diagnosed before age 21 years and > 5 years from diagnosis and/or > 2 years off therapy. All data were independently abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS The search yielded 7021 unique publications. Forty-six were included in the current review. Meta-analyses revealed survivors of CNS tumors were significantly more likely to have completed compulsory education only (OR = 1.87, 95% CI = 1.66, 2.12, p < 0.00001), less likely to be married (OR = 4.70, 95% CI = 3.89, 5.68, p < 0.00001), and more likely to be unemployed (OR = 2.84, 95% CI = 2.62, 3.08, p < 0.00001) compared to non-cancer controls. Cranial radiation therapy, neurocognitive deficits, and younger age at diagnosis were associated with poorer outcomes. Hearing loss and bilateral blindness were also related to poorer outcomes. Sex did not impact social attainment outcomes. CONCLUSIONS Survivors of pediatric CNS tumors are at elevated risk for poor attainment of key adult social outcomes. IMPLICATIONS FOR CANCER SURVIVORS There is a critical need to develop interventions to support survivors in becoming independent and productive adults.
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19
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D'Souza AM, Devine KA, Reiter-Purtill J, Gerhardt CA, Vannatta K, Noll RB. Internalizing symptoms in AYA survivors of childhood cancer and matched comparisons. Psychooncology 2019; 28:2009-2016. [PMID: 31325346 DOI: 10.1002/pon.5183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE As the number of pediatric cancer survivors increases, so does our need to understand behavioral late effects. Prior studies show mixed results, with some noting increased emotional distress and psychiatric diagnoses in cancer survivors and others suggesting resilience. The purpose of our study was to evaluate internalizing symptoms such as anxiety and depression in young adult survivors of childhood cancer compared with matched classroom matched peers. METHOD We completed a multisource, cross-sectional examination of internalizing symptoms using a semistructured psychiatric interview with 18-year-olds with a history of pediatric cancer compared with age, race, and gender matched classroom peers who had been identified during the survivor's first year of treatment and their primary caregivers. RESULTS Fifty-seven young adult survivors of childhood cancer and 60 comparison peers participated. There were no significant differences between survivors and their peers on the basis of self- or parent-reported depressive or anxiety symptoms or number of psychiatric diagnoses. CONCLUSIONS Young adult survivors of childhood cancer and their parents did not report increased rates of anxiety or depression compared with their former classroom peers. Despite experiencing a major life challenge, this group of young adults with cancer did not report more current or past symptoms of internalizing psychopathology.
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Affiliation(s)
- Amber M D'Souza
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Katie A Devine
- Division of Medical Oncology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Jennifer Reiter-Purtill
- Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Kathryn Vannatta
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Robert B Noll
- Department of Pediatrics, Division of Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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Resteghini C, Trama A, Borgonovi E, Hosni H, Corrao G, Orlandi E, Calareso G, De Cecco L, Piazza C, Mainardi L, Licitra L. Big Data in Head and Neck Cancer. Curr Treat Options Oncol 2018; 19:62. [DOI: 10.1007/s11864-018-0585-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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21
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Brinkman TM, Recklitis CJ, Michel G, Grootenhuis MA, Klosky JL. Psychological Symptoms, Social Outcomes, Socioeconomic Attainment, and Health Behaviors Among Survivors of Childhood Cancer: Current State of the Literature. J Clin Oncol 2018; 36:2190-2197. [PMID: 29874134 PMCID: PMC6053297 DOI: 10.1200/jco.2017.76.5552] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The diagnosis, treatment, and medical late effects of childhood cancer may alter the psychosocial trajectory of survivors across their life course. This review of the literature focuses on mental health symptoms, achievement of social milestones, socioeconomic attainment, and risky health behaviors in survivors of childhood cancer. Results suggest that although most survivors are psychologically well adjusted, survivors are at risk for anxiety and depression compared with siblings. Although the absolute risk of suicide ideation and post-traumatic stress symptoms is low, adult survivors are at increased risk compared with controls. Moreover, young adult survivors are at risk for delayed psychosexual development, lower rates of marriage or cohabitation, and nonindependent living. Survivors' socioeconomic attainment also is reduced, with fewer survivors graduating college and gaining full-time employment. Despite risk for late health-related complications, survivors of childhood cancer generally engage in risky health behaviors at rates similar to or only slightly lower than siblings and peers. CNS tumors and CNS-directed therapies are salient risk factors for poor psychosocial outcomes. In addition, physical health morbidities resulting from cancer-directed therapies are associated with worse psychosocial functioning. Several studies support the effectiveness of cognitive and behavioral interventions to treat psychological symptoms as well as to modify health behaviors. Additional randomized controlled trials are needed to evaluate the efficacy and long-term outcomes of intervention efforts. Future research should focus on the identification of potential genetic predispositions related to psychosocial outcomes to provide opportunities for preventive interventions among survivors of childhood cancer.
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Affiliation(s)
- Tara M Brinkman
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Christopher J Recklitis
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gisela Michel
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Martha A Grootenhuis
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - James L Klosky
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Lehmann V, Keim MC, Ferrante AC, Olshefski RS, Gerhardt CA. Psychosexual development and satisfaction with timing of developmental milestones among adult survivors of childhood cancer. Psychooncology 2018; 27:1944-1949. [DOI: 10.1002/pon.4746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Vicky Lehmann
- Center for Biobehavioral Health; The Research Institute at Nationwide Children's Hospital; Columbus OH USA
- Department of Psychology; St. Jude Children's Research Hospital; Memphis TN USA
| | | | - Amanda C. Ferrante
- Center for Biobehavioral Health; The Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Randal S. Olshefski
- Division of Pediatric Hematology/Oncology; Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral Health; The Research Institute at Nationwide Children's Hospital; Columbus OH USA
- Department of Pediatrics; The Ohio State University; Columbus OH USA
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23
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Huang IC, Jones CM, Brinkman TM, Hudson MM, Srivastava DK, Li Y, Robison LL, Krull KR. Development of the functional social network index for adolescent and young adult cancer survivors. Cancer 2018. [PMID: 29517807 DOI: 10.1002/cncr.31278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To the authors' knowledge, social network status in adolescent and young adult (AYA) cancer survivors has not been adequately studied to date. The authors developed and validated a functional social network index (FSNI) for AYA survivors, and compared its performance with that of 2 traditional indices (density and betweenness centrality). METHODS A total of 102 AYA survivors and 102 noncancer controls who were matched for age, sex, and race were recruited from an Internet panel. Each participant reported relationships with up to 25 close friends and/or relatives. The authors developed a FSNI with reported marital status, contact frequency with friends/relatives, available resources for emotional and tangible support, and available resources for physical activity and weight management advice. Linear regression was used to analyze associations between the FSNI and cancer diagnoses, treatments, and coping skills. RESULTS Based on the FSNI, survivors were found to have more available resources for emotional support (beta [b] = 3.02; P = .003), tangible support (b = 4.17; P<.001), physical activity advice (b = 3.94; P<.001), and weight management advice (b = 4.10; P<.001) compared with noncancer controls. Survivors of lymphoma had the largest FSNI, whereas survivors of central nervous system malignancies had the smallest (b = 2.77; P = .02). A higher FSNI was associated with better coping skills: less denial (b = 0.10; P = .01), using emotional support (b = 0.08; P = .04), using instrumental support (b = 0.12; P<.001), less behavioral disengagement (b = 0.08; P = .04), venting of emotions (b = 0.10; P = .004), positive reframing (b = 0.12; P = .003), planning for the future (b = 0.08; P = .03), and religious engagement (b = 0.16; P<.001). Density and betweenness centrality indices demonstrated neither significant differences in social networks between cancer survivors and controls (all P values >.05) nor significant associations with coping skills (all P values >.05). CONCLUSIONS The FSNI appears to provide a better social network assessment for AYA cancer survivors than traditional indices. Cancer 2018;124:2220-7. © 2018 American Cancer Society.
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Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Conor M Jones
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - D Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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24
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Nies M, Dekker BL, Sulkers E, Huizinga GA, Klein Hesselink MS, Maurice-Stam H, Grootenhuis MA, Brouwers AH, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, van der Horst-Schrivers ANA, Tissing WJE, Bocca G, Links TP. Psychosocial development in survivors of childhood differentiated thyroid carcinoma: a cross-sectional study. Eur J Endocrinol 2018; 178:215-223. [PMID: 29254931 PMCID: PMC5811933 DOI: 10.1530/eje-17-0741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The impact of childhood differentiated thyroid carcinoma (DTC) on psychosocial development has not yet been studied. The aim of this study was to evaluate the achievement of psychosocial developmental milestones in long-term survivors of childhood DTC. DESIGN AND METHODS Survivors of childhood DTC diagnosed between 1970 and 2013 were included. Reasons for exclusion were age <18 or >35 years at follow-up, a follow-up period <5 years or diagnosis with DTC as a second malignant neoplasm. Survivors gathered peer controls of similar age and sex (n = 30). A comparison group non-affected with cancer (n = 508) and other childhood cancer survivors (CCS) were also used to compare psychosocial development. To assess the achievement of psychosocial milestones (social, autonomy and psychosexual development), the course of life questionnaire (CoLQ) was used. RESULTS We included 39 survivors of childhood DTC (response rate 83.0%, mean age at diagnosis 15.6 years, and mean age at evaluation 26.1 years). CoLQ scores did not significantly differ between survivors of childhood DTC and the two non-affected groups. CoLQ scores of childhood DTC survivors were compared to scores of other CCS diagnosed at similar ages (n = 76). DTC survivors scored significantly higher on social development than other CCS, but scores were similar on autonomy and psychosexual developmental scales. CONCLUSIONS Survivors of childhood DTC showed similar development on social, autonomy, and psychosexual domains compared to non-affected individuals. Social development was slightly more favorable in DTC survivors than in other CCS, but was similar on autonomy and psychosexual domains.
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Affiliation(s)
- Marloes Nies
- Division of EndocrinologyDepartment of Internal Medicine
| | | | - Esther Sulkers
- Department of Wenkebach InstituteSchool of Nursing and Health and Beatrix Children’s Hospital
| | - Gea A Huizinga
- Department of Wenkebach InstituteSchool of Nursing and Health and Beatrix Children’s Hospital
- Department of Pediatric OncologyUniversity of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Martha A Grootenhuis
- Psychosocial DepartmentAcademic Medical Center, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
| | | | - Johannes G M Burgerhof
- Department of EpidemiologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eveline W C M van Dam
- Division of Endocrinology, Department of Internal MedicineVU University Medical Center, Amsterdam, the Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal MedicineMaastricht University Medical Center, Maastricht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
- Department of Pediatric OncologyRotterdam, the Netherlands
| | - Eleonora P M Corssmit
- Division of Endocrinology, Department of Internal MedicineLeiden University Medical Center, Leiden, the Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
- Department of Pediatric OncologyAcademic Medical Center, Amsterdam, the Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal MedicineRadboud University Medical Center, Nijmegen, the Netherlands
| | - Heleen J H van der Pal
- Princess Máxima Center for Pediatric OncologyUtrecht, the Netherlands
- Department of Medical Oncology and Emma Children’s Hospital/Academic Medical CenterAmsterdam, the Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Rotterdam Thyroid Center Erasmus Medical CenterRotterdam, the Netherlands
| | - John T M Plukker
- Department of Surgical OncologyUniversity of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Cécile M Ronckers
- Department of Pediatric OncologyAcademic Medical Center, Amsterdam, the Netherlands
| | - Hanneke M van Santen
- Department of PediatricsUniversity Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, the Netherlands
| | | | - Wim J E Tissing
- Department of Pediatric OncologyUniversity of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Gianni Bocca
- Department of Pediatric EndocrinologyUniversity of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Division of EndocrinologyDepartment of Internal Medicine
- Correspondence should be addressed to T P Links
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25
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Baenziger J, Roser K, Mader L, Christen S, Kuehni CE, Gumy-Pause F, Tinner EM, Michel G. Can the theory of planned behavior help explain attendance to follow-up care of childhood cancer survivors? Psychooncology 2018; 27:1501-1508. [PMID: 29473254 DOI: 10.1002/pon.4680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Childhood cancer survivors are at high risk for late effects. Regular attendance to long-term follow-up care is recommended and helps monitoring survivors' health. Using the theory of planned behavior, we aimed to (1) investigate the predictors of the intention to attend follow-up care, and (2) examine the associations between perceived control and behavioral intention with actual follow-up care attendance in Swiss childhood cancer survivors. METHODS We conducted a questionnaire survey in Swiss childhood cancer survivors (diagnosed with cancer aged <16 years between 1990 and 2005; ≥5 years since diagnosis). We assessed theory of planned behavior-related predictors (attitude, subjective norm, perceived control), intention to attend follow-up care, and actual attendance. We applied structural equation modeling to investigate predictors of intention, and logistic regression models to study the association between intention and actual attendance. RESULTS Of 299 responders (166 [55.5%] females), 145 (48.5%) reported attending follow-up care. We found that subjective norm, ie, survivors' perceived social pressure and support (coef = 0.90, P < 0.001), predicted the intention to attend follow-up; attitude and perceived control did not. Perceived control (OR = 1.58, 95%CI:1.04-2.41) and intention to attend follow-up (OR = 6.43, 95%CI:4.21-9.81) were positively associated with attendance. CONCLUSIONS To increase attendance, an effort should be made to sensitize partners, friends, parents, and health care professionals on their important role in supporting survivors regarding follow-up care. Additionally, interventions promoting personal control over the follow-up attendance might further increase regular attendance.
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Affiliation(s)
- Julia Baenziger
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Luzius Mader
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Salome Christen
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Fabienne Gumy-Pause
- Department of Pediatrics, Onco-Hematology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Eva Maria Tinner
- Division of Pediatric Hematology/Oncology, University Children's Hospital Bern, Bern, 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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26
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Lehmann V, Hagedoorn M, Gerhardt CA, Keim MC, Guthrie L, Sanderman R, Tuinman MA. Memories of Parent Behaviors and Adult Attachment in Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:134-141. [DOI: 10.1089/jayao.2016.0033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vicky Lehmann
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, Ohio
- The Ohio State University, Department of Pediatrics, Columbus, Ohio
| | - Mariët Hagedoorn
- University Medical Center Groningen (UMCG), University of Groningen, Healthy Psychology Research Section, Groningen, The Netherlands
| | - Cynthia A. Gerhardt
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, Ohio
- The Ohio State University, Department of Pediatrics, Columbus, Ohio
| | - Madelaine C. Keim
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, Ohio
| | | | - Robbert Sanderman
- University Medical Center Groningen (UMCG), University of Groningen, Healthy Psychology Research Section, Groningen, The Netherlands
| | - Marrit A. Tuinman
- University Medical Center Groningen (UMCG), University of Groningen, Healthy Psychology Research Section, Groningen, The Netherlands
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27
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Lehmann V, Tuinman MA, Keim MC, Winning AM, Olshefski RS, Bajwa RPS, Hagedoorn M, Gerhardt CA. Psychosexual development and satisfaction in long-term survivors of childhood cancer: Neurotoxic treatment intensity as a risk indicator. Cancer 2017; 123:1869-1876. [PMID: 28165611 DOI: 10.1002/cncr.30513] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Risk factors for impairment in psychosexual development and satisfaction among adult survivors of childhood cancer are poorly understood. The authors compared psychosexual outcomes between survivors and healthy controls, and tested whether at-risk survivors can be identified by 1) treatment neurotoxicity or 2) diagnosis. METHODS A total of 144 young adult survivors of childhood cancer and 144 matched controls completed questionnaires regarding psychosexual development, sexual satisfaction, and satisfaction with relationship status. Survivors were aged 20 to 40 years and were 5 to 34 years after diagnosis. Using medical chart data, survivors were divided into non-neurotoxic (48 survivors), low-dose (36 survivors), and high-dose (58 survivors) neurotoxic treatment groups. RESULTS Apart from having fewer lifetime sex partners, survivors did not appear to differ from controls. However, survivors of brain tumors and any survivor who received high-dose neurotoxic treatment reported the lowest rates of achieving milestones of psychosexual development, whereas sexual and relationship status satisfaction were found to be related to relationship status. Neurotoxic treatment intensity further distinguished between survivors of brain tumors with and without psychosexual impairment. CONCLUSIONS The intensity of neurotoxic treatment may be a valuable indicator of risk for psychosexual impairment relative to diagnosis alone. Health care providers should assess romantic/sexual problems among survivors at risk and make referrals if needed. Cancer 2017;123:1869-1876. © 2017 American Cancer Society.
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Affiliation(s)
- Vicky Lehmann
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Marrit A Tuinman
- Healthy Psychology Research Section, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Madelaine C Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Adrien M Winning
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Randal S Olshefski
- Hematology/Oncology & BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Rajinder P S Bajwa
- Hematology/Oncology & BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Mariët Hagedoorn
- Healthy Psychology Research Section, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University, Columbus, Ohio
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28
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Merz EL, Tomfohr-Madsen L. Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment. Am J Lifestyle Med 2016; 12:311-323. [PMID: 32063816 DOI: 10.1177/1559827616681725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022] Open
Abstract
Sleep disruption is a commonly reported consequence of cancer and its treatment in pediatric patients and survivors. This review summarizes common sleep concerns in this population and introduces a multidimensional framework of risk factors specific to childhood cancer that may interact to develop and maintain disrupted sleep. Based on the extant literature, parameters of the cancer and its treatment, physical and social environmental conditions both during and after treatment, changes to family behavior and norms, psychological factors and traumatic stress, and reduced physical activity are hypothesized to be the most pertinent risk factors for disrupted sleep in this population. Potential clinical assessment strategies and behavioral interventions relevant to these considerations are discussed, with reference to the behavioral model of insomnia. The review concludes by offering directions for research and clinical practice, including developing and testing comprehensive assessment tools, intervention effectiveness studies in both oncology and primary care clinics, and efforts to increase patient-provider communication about sleep in pediatric oncology.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
| | - Lianne Tomfohr-Madsen
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
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29
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Janzen LA. Long-term neurocognitive and functional effects of treatment for childhood acute lymphoblastic leukaemia. Lancet Psychiatry 2016; 3:912-913. [PMID: 27639662 DOI: 10.1016/s2215-0366(16)30278-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Laura A Janzen
- Department of Psychology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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