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Russell KB, Roberts A, Wright H, Henry B, Omobhude OF, Holmer P, Drummond R, Verhesen T, Forbes C, Stokoe M, Tomfohr-Madsen L, Schulte F. Fear of cancer recurrence experienced by pediatric survivors of childhood cancer: a scoping review. Support Care Cancer 2024; 32:588. [PMID: 39141180 DOI: 10.1007/s00520-024-08795-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 08/08/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE In contrast to the extensive literature on fear of cancer recurrence (FCR) experienced by adults, literature evaluating pediatric FCR has just begun to emerge. Given the rapidly expanding body of work assessing FCR in childhood and adolescence, a scoping review was conducted to synthesize existing findings. We aimed to assess (1) the characteristics and methods of this literature, (2) how pediatric FCR has been measured, and (3) the extant knowledge of FCR experienced by pediatric survivors of cancer. METHODS Inclusion criteria were: (1) original reports, (2) participants diagnosed with cancer before age 18, (3) current mean age under 18, (4) FCR was explicitly measured (quantitatively) or captured (qualitatively) via survivor self-report, and (6) published in English. Exclusion criteria were: (1) case studies, and (2) grey literature. Three databases (Embase, MEDLINE, PsycINFO) and reference lists from included studies were searched. All studies were screened for inclusion by two authors and all data were extracted by a single author. RESULTS Of 3906 identified studies, 19 were included. Studies (published 1991 - 2023) encompassed diverse geographical locations, study designs, and measurement methods. Few assessed FCR as a primary aim (n = 6, 32%). FCR was experienced by 43 - 90% of pediatric survivors. FCR was often positively associated with somatic symptoms and negatively associated with quality of life and emotional functioning. CONCLUSION FCR is a prevalent issue for children and adolescents. Additional evidence is needed to explore and confirm preliminary findings. Future pediatric FCR studies should aim to align with published priority research areas.
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Affiliation(s)
- K Brooke Russell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Araby Roberts
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Holly Wright
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Brianna Henry
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Oserekpamen Favour Omobhude
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Pauline Holmer
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Rachelle Drummond
- Cumming School of Medicine, Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Tessa Verhesen
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Caitlin Forbes
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada
| | - Mehak Stokoe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Lianne Tomfohr-Madsen
- Department of Educational and Counselling Psychology, and Special Education (ECPS), University of British Columbia, Vancouver, BC, Canada
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, 2202 2 St SW, Calgary, AB, T2S 3C3, Canada.
- Hematology, Oncology, and Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada.
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2
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Larsen EH, Wahl AK, Ruud E, Mellblom AV, Ålykkja A, Lie HC. Adolescent Cancer Survivors and Their Parents' Experiences With the Transition Off Treatment to Survivorship: A Qualitative Interview Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:172-187. [PMID: 38656765 DOI: 10.1177/27527530231214528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Transitioning from active cancer treatment to survivorship represents a vulnerable yet underresearched phase for adolescents and their families. Knowledge of their support needs, the challenges they experience, and how they manage them are useful to inform tailored follow-up care. Thus, we aimed to explore their transition experiences. Method: We interviewed 15 adolescents (12-19 years) who had transitioned off of treatment 1 to 47 months prior at Oslo University Hospital's Department of Paediatric Haematology and Oncology and their biological parents (n = 16). The interviews were analyzed using inductive, reflexive thematic analysis inspired by Braun and Clarke. NVivo-12 was used for data management. Results: Four main themes were identified: (a) consequences of cancer beyond transition, (b) transition back to normalcy, (c) survivorship competence, and (d) changes in roles and relationships. The families described happiness and relief but also said that the lingering effects of cancer treatment had a profound impact on day-to-day living. The adolescents expressed closeness with and dependency on their parents, and they perceived family and friends as essential for social readjustment. Discussion: Although adolescent survivors and their parents described a wide variety of strategies for returning to "normalcy," their perspectives also illustrate ongoing psychosocial and educational support needs that changed over time. Our findings indicate a need for improved preparation for and support through the transition. Nurses are well positioned to provide continuous and structured transition support tailored to the needs of the individual survivors and their families.
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Affiliation(s)
- Elna Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Anneli Viktoria Mellblom
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Nydalen, Oslo, Norway
| | - Anette Ålykkja
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
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3
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Turan SA, Kudubeş AA, Gürcan M, Akcan A, Sarvan S, Bektaş M. Development and psychometric analysis of a pediatric cancer survivors Psychosocial Late Effects Scale (PCSLES). J Pediatr Nurs 2024; 76:e109-e116. [PMID: 38307759 DOI: 10.1016/j.pedn.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Although the physiological late effects of childhood cancer survivors are more obvious, appropriate assessment of psychosocial effects is needed. Therefore, it was aimed to develop a scale to evaluate psychosocial late effects in cancer survivors and to test its validity and reliability. DESIGN AND METHODS This methodological study was conducted with 100 children and adolescents who survived were collected at the oncology center in the south of Türkiye in 2022. Data were collected with the "Personal Information Form" and "Pediatric Cancer Survivors Psychosocial Late Effects Scale (PCSLES)" IBM SPSS 24.0 and IBM AMOS 24.0 software programs were used for data analysis, and descriptive statistics were used to analyze numeric variables. Exploration and confirmatory factor analyses were performed to determine the scale's factorial structure. RESULTS The factorial analysis was used to test the structural validity of the scale. A four-factor structure consisting of 17 items was developed. The Cronbach's alpha coefficient for "1" was 0.89, "2" was 0.87, "3" was 0.80, "4" was 0.82 and the total score was 0.92. Fit indices resulting from the study were χ2/SD: 1.497, root mean square error of approximation (RMSEA): 0.071, goodnessof-fit index (GFI): 0.85, comparative-of-fit index (CFI): 0.94, and normed fit index (NFI): 0.85. CONCLUSION The scale is a valid and reliable scale that can be used to determine psychosocial late effects in pediatric cancer patients. PRACTICE IMPLICATIONS Utilizing the PCSLES can assist in identifying the psychosocial symptoms of child survivors/adolescents and facilitate the planning of appropriate interventions.
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Affiliation(s)
- Sevcan Atay Turan
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Türkiye
| | - Aslı Akdeniz Kudubeş
- Department of Pediatric Nursing, Faculty of Health Sciences, Bilecik Şeyh Edebali University, Bilecik, Türkiye.
| | - Meltem Gürcan
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Türkiye.
| | - Arzu Akcan
- Department of Public Health Nursing, Faculty of Nursing, Akdeniz University, Antalya, Türkiye.
| | - Süreyya Sarvan
- Department of Pediatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Türkiye.
| | - Murat Bektaş
- Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylül University, İzmir, Türkiye.
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4
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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5
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Wang S, Jiang Y, Zheng R, Yu Y, Wei W, Li N. Mobilizing China and the Global Community to Confront the Treatment Desert for Pediatric Solid Tumors. Cancer Discov 2024; 14:26-29. [PMID: 38213295 PMCID: PMC10784741 DOI: 10.1158/2159-8290.cd-23-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
SUMMARY Pediatric solid tumors are distinct clinical entities that impose heavy socioeconomic burden and while their incidence has increased in recent years, treatment options are often limited, with only 27 drugs approved for pediatric solid tumors in the United States, and fewer still, 13, in China. The scale of the unmet medical need is immense and new efforts are urgently needed to develop efficient therapeutics and improve these children's lives.
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Affiliation(s)
- Shuhang Wang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yale Jiang
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongshou Zheng
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Yu
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqiang Wei
- National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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6
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Horwood M, Loades ME, Kosir U, Davis C. Illness Perceptions, Fear of Cancer Recurrence, and Mental Health in Teenage and Young Adult Cancer Survivors. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:44-55. [PMID: 37956647 DOI: 10.1177/27527530231190378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background: The Common-Sense Model of illness self-regulation underpins illness-specific cognitions (including both illness perceptions and a fear of cancer recurrence; FCR). There is evidence in adults of associations between FCR, illness perceptions, and mental health in adult cancer survivors. However, there is limited empirical research examining these constructs within the developmentally distinct population of adolescent and young adult (AYA) survivors of cancer. The current study aimed to bridge that gap to inform potentially modifiable treatment targets in this population. Method: A cross-sectional, correlational design was used to examine the associations between illness perceptions, FCR, and mental health. A web-based survey was completed by a convenience sample of AYA survivors. Regression and mediation analyses were performed. Results: Overall, more negative illness perceptions were associated with more severe FCR and greater depressive and anxiety symptomatology. Higher FCR was predictive of worse overall mental health. More negative overall illness perceptions predicted the relationship between FCR-depression, mediating 24.1% of the variance. Contrastingly, overall illness perceptions did not predict or mediate the relationship between FCR-anxiety. However, the specific illness perceptions regarding timeline, personal control, and emotional representation, were predictive of the FCR-anxiety relationship. Discussion: Illness perceptions and FCR were predictive of mental health outcomes. Identifying and therapeutically targeting negative illness perceptions in those young adults who have survived adolescent cancer could therefore be a means of reducing anxiety and depressive symptomatology. Limitations and future directions are discussed.
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Affiliation(s)
| | | | - Urska Kosir
- Orthopedic Oncology - Sarcoma Team, McGill University Health Centre (Sarcoma Team), Montreal, Canada
| | - Cara Davis
- Department of Psychology, University of Bath, Bath, UK
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7
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De Groef A, Meeus M, Heathcote LC, Wiles L, Catley M, Vogelzang A, Olver I, Runciman WB, Hibbert P, Dams L, Morlion B, Moseley GL. Treating persistent pain after breast cancer: practice gaps and future directions. J Cancer Surviv 2023; 17:1698-1707. [PMID: 35275361 PMCID: PMC8914454 DOI: 10.1007/s11764-022-01194-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/29/2022]
Abstract
This paper discusses the growing problem of persisting pain after successful treatment of breast cancer and presents recommendations for improving pain-related outcomes for this group. We discuss the dominant treatment approach for persisting pain post-breast cancer treatment and draw contrasts with contemporary treatment approaches to persistent pain in non-cancer-related populations. We discuss modern application of the biopsychosocial model of pain and the notion of variable sensitivity within the pain system, moment by moment and over time. We present the implications of increasing sensitivity over time for treatment selection and implementation. By drawing on transformative changes in treatment approaches to persistent non-cancer-related pain, we describe the potentially powerful role that an intervention called pain science education, which is now recommended in clinical guidelines for musculoskeletal pain, may play in improving pain and disability outcomes after successful breast cancer treatment. Finally, we present several research recommendations that centre around adaptation of the content and delivery models of contemporary pain science education, to the post-breast cancer context.
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Affiliation(s)
- An De Groef
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium.
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium.
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Louise Wiles
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Mark Catley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Anna Vogelzang
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - William B Runciman
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter Hibbert
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Lore Dams
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Campus Drie Eiken, Room R3.08, Universiteitsplein 1, 2610, Wilrijk Antwerp, Belgium
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - Bart Morlion
- Section Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, University of Leuven, Leuven, Belgium
| | - G Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, South Australia, Australia
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8
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Youlden DR, Baade PD, Aitken JF. Long-term childhood cancer survival in Australia using period estimation. Pediatr Blood Cancer 2023; 70:e30136. [PMID: 36495243 DOI: 10.1002/pbc.30136] [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: 09/19/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
Estimates of childhood cancer survival are usually reported at 5 years after diagnosis only. Using cases prevalent between 2014 and 2018 from the population-based Australian Childhood Cancer Registry, we used the period method to calculate relative survival up to 20 years post diagnosis by cancer type. Twenty-year relative survival for all childhood cancers combined (n = 14,353) was 83.8% (95% confidence interval [CI] = 82.6%-85.0%). Survival decreased only slightly after 10 years for most childhood cancers, except for some types of brain and liver tumours. These contemporary estimates of long-term survival provide valuable information to assist childhood cancer patients and their families in planning for the future.
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Affiliation(s)
- Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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9
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Heathcote LC, Cunningham SJ, Webster SN, Tanna V, Mattke E, Loecher N, Spunt SL, Simon P, Dahl G, Walentynowicz M, Murnane E, Tutelman PR, Schapira L, Simons LE, Mueller C. Smartphone-based Ecological Momentary Assessment to study "scanxiety" among Adolescent and Young Adult survivors of childhood cancer: A feasibility study. Psychooncology 2022; 31:1322-1330. [PMID: 35411626 PMCID: PMC9545782 DOI: 10.1002/pon.5935] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Scan-related anxiety ("scanxiety") refers to the fear, stress, and anxiety in anticipation of tests and scans in follow-up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real-world, real-time capture of scanxiety using patients' personal smartphone. METHODS Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. RESULTS Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. CONCLUSIONS Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety.
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Affiliation(s)
- Lauren C. Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Sarah J. Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Sarah N. Webster
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Vivek Tanna
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Elia Mattke
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Nele Loecher
- Department of Mental Health Law and PolicyUniversity of South FloridaTampaFloridaUSA
| | - Sheri L. Spunt
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Pamela Simon
- Lucile Packard Children's Hospital at StanfordPalo AltoCaliforniaUSA
| | - Gary Dahl
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Marta Walentynowicz
- Centre for the Psychology of Learning and Experimental Psychopathology, KU LeuvenLeuvenBelgium
- Psychological Science Research InstituteUniversité Catholique de LouvainLouvain‐la‐NeuveBelgium
| | | | | | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of MedicineStanfordCaliforniaUSA
| | - Claudia Mueller
- Department of Pediatrics, Stanford University School of MedicineStanfordCaliforniaUSA
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10
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Unique associations of pain frequency and pain-related worry with health-related quality of life in survivors of childhood cancer. Pain Rep 2022; 7:e1000. [PMID: 35415383 PMCID: PMC8989778 DOI: 10.1097/pr9.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
More than one-third of childhood cancer survivors are worried about pain as a sign of disease recurrence; pain-related worry explained unique variance in health-related quality of life. Introduction: Pain is common during childhood cancer treatment, can persist into survivorship, and can negatively affect health-related quality of life in survivors of childhood cancers (SCCs). Objective: The objective of this brief report was to assess pain frequency, pain-related worry, and their (unique) associations with health-related quality of life in SCCs. Methods: One hundred eleven SCCs (52% female individuals, M age: 17.67 years, range 8–25 years) completed self-report measures of pain frequency, pain-related worry, and health-related quality of life. Results: More than two-thirds (70%) of SCCs reported pain in the previous month (M = 1.39, SD = 1.17), and 15% reported experiencing pain often or almost always. More than one-third (39%) reported worrying about pain as a sign of cancer recurrence (M = 0.73, SD = 1.07), and 9% reported worrying about pain a lot or a whole lot. In multivariate regression models that controlled for sex, age at diagnosis, and time off treatment, both pain frequency and pain-related worry were significantly associated with physical health-related quality of life, indicating that they contribute unique variance to health-related quality of life after childhood cancer. For emotional health-related quality of life, pain frequency was no longer a significant predictor once pain-related worry was added to the model, indicating that pain-related worry may be particularly important for understanding emotional health-related quality of life. Conclusion: Postcancer pain may contribute to health-related quality of life through multiple mechanisms, including by triggering concerns of recurrence. There is a need for clinical interventions that target both the frequency of pain (eg, behavioral interventions) and pain-related worry (eg, psychoeducation and cognitive interventions) to improve health-related quality of life after childhood cancer.
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11
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Tutelman PR, Chambers CT, Heathcote LC, Fernandez CV, Flanders A, Patton M, Schulte FSM, Guilcher GMT, Simard S, MacLeod J, Stern M. Measuring Fear of Cancer Recurrence in Survivors of Childhood Cancer: Development and Preliminary Validation of the FCRI-Child and FCRI-Parent Versions. Psychooncology 2022; 31:911-919. [PMID: 35018689 DOI: 10.1002/pon.5879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common and distressing psychosocial concern for adult cancer survivors. Data on this construct in child survivors is limited and there are no validated measures for this population. This study aimed to adapt the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) for survivors of childhood cancer aged 8-18 years (FCRI-C) and their parents (FCRI-P) to self-report on their own FCR and to examine the initial psychometric properties. METHODS The FCRI-SF was adapted through expert panel input and cognitive interviews with child survivors <18 years. The factor structure, internal consistency and construct and criterion validity of the FCRI-C and FCRI-P were examined in 124 survivors of childhood cancer (43% female; Mage =14.58 years, SD=2.90) and 106 parents (90% mothers). RESULTS All FCRI-SF items were retained for the FCRI-C with simplified language. The internal consistencies of the FCRI-C (α= .88) and FCRI-P (α= .83) were good. Exploratory factor analyses yielded one-factor structures for both measures. Higher scores on the FCRI-C and FCRI-P were associated with greater intolerance of uncertainty and pain catastrophizing. Higher child FCR was also related to more hypervigilance to bodily symptoms. Parents with higher FCR reported contacting their child's doctors and nurses and scheduling medical appointments for their child more frequently. Children reported significantly lower FCR compared to parents. CONCLUSIONS The FCRI-C and FCRI-P demonstrated strong reliability and preliminary validity. This study offers preliminary data to support the use of the FCRI-C and FCRI-P to measure FCR in survivors of childhood cancer aged 8-18 years and their parents. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California, USA
| | - Conrad V Fernandez
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annette Flanders
- Division of Pediatric Hematology-Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Gregory M T Guilcher
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sébastien Simard
- Department of Health Sciences, Centre intersectoriel en santé durable (CIUSD), Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | | | - Maya Stern
- Patient Partner, Toronto, Ontario, Canada
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A systematic mixed studies review of fear of cancer recurrence in families and caregivers of adults diagnosed with cancer. J Cancer Surviv 2021; 16:1184-1219. [PMID: 34762248 DOI: 10.1007/s11764-021-01109-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) may be equally prevalent, persistent and burdensome in cancer caregivers as in survivors. This systematic review evaluated FCR prevalence, severity, correlates, course, impact and interventions in cancer caregivers. METHODS Electronic databases were searched from 1997 to May 2021. Two reviewers identified eligible peer-reviewed qualitative or quantitative studies on FCR in adult caregivers or family members of adult cancer survivors. The risk of bias was assessed using the Cochrane Risk of Bias tools for randomised and non-randomised studies and the Mixed-Methods Appraisal Tool. A narrative synthesis and thematic synthesis occurred on quantitative and qualitative studies, respectively. RESULTS Of 2418 papers identified, 70 reports (59 peer-reviewed articles, 11 postgraduate theses) from 63 studies were included. Approximately 50% of caregivers experienced FCR. Younger caregivers and those caring for survivors with worse FCR or overall health reported higher FCR. Most studies found caregivers' FCR levels were equal to or greater than survivors'. Caregivers' FCR was persistently elevated but peaked approaching survivor follow-up appointments. Caregivers' FCR was associated with poorer quality of life in caregivers and survivors. Three studies found couple-based FCR interventions were acceptable, but had limited efficacy. CONCLUSIONS FCR in caregivers is prevalent, persistent and burdensome. Younger caregivers of survivors with worse overall health or FCR are at the greatest risk. Further research on identifying and treating caregivers' FCR is required. IMPLICATIONS FOR CANCER SURVIVORS Caregiver and survivor FCR are similarly impactful and appear interrelated. Addressing FCR may improve outcomes for both cancer caregivers and survivors.
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Yardeni M, Abebe Campino G, Hasson‐Ohayon I, Basel D, Hertz‐Palmor N, Bursztyn S, Weisman H, Pessach IM, Toren A, Gothelf D. Trajectories and risk factors for anxiety and depression in children and adolescents with cancer: A 1-year follow-up. Cancer Med 2021; 10:5653-5660. [PMID: 34309238 PMCID: PMC8366094 DOI: 10.1002/cam4.4100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is limited data on the longitudinal trajectories of psychiatric disorders in children with cancer and risk factors for their persistence. The current study aimed to longitudinally assess the trajectories and risk factors for anxiety and depressive symptoms and disorders in children and adolescents with cancer. METHODS Children and adolescents with cancer and their parents completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety Module and were interviewed by the semi-structured Affective and Anxiety Modules of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), at 4 time points, 1, 4, 7, and 12 months following the diagnosis of cancer. RESULTS Of the 99 patients enrolled, 48% met criteria for anxiety and/or depressive disorders at least once during the follow-up period. There was a significant decrease in PROMIS pediatric and parent anxiety and depression scores (all p's < 0.01) and in the rate of depressive disorders over time (p = 0.02), while rates of anxiety disorders remained stable. Anxiety PROMIS pediatric and parent scores at baseline, having brain tumors and being in the acute treatment phase significantly predicted the presences of anxiety disorders at endpoint. CONCLUSIONS Our results highlight the importance of screening for anxiety and disorders in children with cancer, especially among those with brain tumors and at the acute phase of treatment.
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Affiliation(s)
| | - Gadi Abebe Campino
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | | | - Dana Basel
- The Chaim Sheba Medical CenterRamat GanIsrael
| | | | | | | | - Itai M. Pessach
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Amos Toren
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Doron Gothelf
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
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14
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Peikert ML, Inhestern L, Krauth KA, Escherich G, Rutkowski S, Kandels D, Schiekiera LJ, Bergelt C. Fear of progression in parents of childhood cancer survivors: prevalence and associated factors. J Cancer Surviv 2021; 16:823-833. [PMID: 34302272 PMCID: PMC9300493 DOI: 10.1007/s11764-021-01076-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/14/2021] [Indexed: 10/29/2022]
Abstract
PURPOSE Recent research demonstrated that fear of progression (FoP) is a major burden for adult cancer survivors. However, knowledge on FoP in parents of childhood cancer survivors is scarce. This study aimed to determine the proportion of parents who show dysfunctional levels of FoP, to investigate gender differences, and to examine factors associated with FoP in mothers and fathers. METHODS Five hundred sixteen parents of pediatric cancer survivors (aged 0-17 years at diagnosis of leukemia or central nervous system (CNS) tumor) were consecutively recruited after the end of intensive cancer treatment. We conducted hierarchical multiple regression analyses for mothers and fathers and integrated parent-, patient-, and family-related factors in the models. RESULTS Significantly more mothers (54%) than fathers (41%) suffered from dysfunctional levels of FoP. Maternal FoP was significantly associated with depression, a medical coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and lower family functioning (adjusted R2 = .30, p < .001). Paternal FoP was significantly associated with a lower level of education, depression, a family coping style, a child diagnosed with a CNS tumor in comparison to leukemia, and fewer siblings (adjusted R2 = .48, p < .001). CONCLUSIONS FoP represents a great burden for parents of pediatric cancer survivors. We identified associated factors of parental FoP. Some of these factors can be targeted by health care professionals within psychosocial interventions and others can provide an indication for an increased risk for higher levels of FoP. IMPLICATIONS FOR CANCER SURVIVORS Psychosocial support targeting FoP in parents of childhood cancer survivors is highly indicated.
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Affiliation(s)
- Mona L Peikert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Laura Inhestern
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Konstantin A Krauth
- Department of Pediatrics, Pediatric Hematology and Oncology, Klinik Bad Oexen, Oexen 27, 32549, Bad Oeynhausen, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniela Kandels
- Swabian Children's Cancer Center, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Louis J Schiekiera
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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15
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Cunningham SJ, Patton M, Schulte F, Richardson PA, Heathcote LC. Worry about somatic symptoms as a sign of cancer recurrence: prevalence and associations with fear of recurrence and quality of life in survivors of childhood cancer. Psychooncology 2021; 30:1077-1085. [PMID: 33544422 DOI: 10.1002/pon.5647] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Somatic symptoms (e.g., pain, fatigue) are common after childhood cancer and are associated with greater fear of cancer recurrence and poorer health-related quality of life (HRQoL). Qualitative studies indicate that survivors of childhood cancer (SCCs) worry about somatic symptoms as indicating cancer recurrence, which could in part explain associations between symptoms and poorer psychosocial outcomes. However, the prevalence, characteristics, and impact of symptom worry has not been quantitatively studied. METHODS SCCs (N = 111; 52% female; Mage at study = 17.67 years, range = 8-25 years; Mage at diagnosis = 6.70 years) across a variety of diagnoses were recruited from a pediatric cancer center in Canada and completed self-report measures of symptom worry, symptom frequency, general anxiety, fear of cancer recurrence, and HRQoL. RESULTS A majority (62%) of SCCs worried about at least one symptom as a sign of recurrence. Pain was the most worrisome symptom, but SCCs also reported worrying about symptoms that are rarely associated with cancer recurrence such as hunger, dizziness, and feeling cold. Symptom worry was more strongly associated with fear of cancer recurrence than the mere frequency of those symptoms, and this relationship held while controlling for treatment factors and general anxiety. Symptom worry and frequency each explained unique variance in HRQoL. CONCLUSIONS Worry about somatic symptoms as a sign of cancer recurrence is common and may be impactful after childhood cancer. Excessive worry about somatic symptoms could be an important target to reduce fear of recurrence and increase HRQoL in SCCs.
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Affiliation(s)
- Sarah J Cunningham
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Schulte
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Patricia A Richardson
- Departments of Pediatric Psychology and Pediatric Pain and Palliative Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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