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Sáez Rodríguez DJ, Ortigosa Quiles JM, Marin AR, Martínez RS. Self-Esteem and Coping Strategies in Adolescent Cancer Patients during the Period of Illness and Follow-Up. Eur J Investig Health Psychol Educ 2024; 14:1128-1139. [PMID: 38785572 PMCID: PMC11120105 DOI: 10.3390/ejihpe14050074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
The importance of self-esteem during the course of oncological illness has been well-documented by some previous studies. However, data assessing its association with various coping strategies, especially considering the period of illness, are still scarce. The objective of this study is to analyze the differences in coping strategies among oncological adolescents, taking into account their self-esteem, illness period, age, and sex. A total of 201 oncological patients between the ages of 12 and 17 from three different Spanish cities were included in this study. All of them were asked to answer a tailored questionnaire, encompassing information about age, sex, and illness period. Additionally, the coping strategies were measured using the ACS scale, while self-esteem was evaluated using the SENA questionnaire. The results demonstrated that male adolescents and older individuals exhibited higher levels of self-esteem. The main coping strategies associated with higher self-esteem were "ignore the problem", "focus on positive", "physical recreation", and "wishful thinking" both during the treatment and the follow-up phases. We conclude that higher self-esteem is associated with some of the coping strategies such as "focus on positive", "ignore the problem", and "wishful thinking". Sociodemographic variables influence the relationship between self-esteem and coping strategies, but no differences were found regarding the period of illness.
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Affiliation(s)
- Diego José Sáez Rodríguez
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Murcia, Espinardo University Campus, 30100 Murcia, Spain; (J.M.O.Q.); (A.R.M.)
| | - Juan Manuel Ortigosa Quiles
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Murcia, Espinardo University Campus, 30100 Murcia, Spain; (J.M.O.Q.); (A.R.M.)
| | - Antonio Riquelme Marin
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Murcia, Espinardo University Campus, 30100 Murcia, Spain; (J.M.O.Q.); (A.R.M.)
| | - Raquel Suriá Martínez
- Department of Communication and Social Psychology, University Institute for Gender Studies Research, University of Alicante, Social Sciences Building, 03690 Alicante, Spain;
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Bourdeau C, Lippé S, Robaey P, Rondeau É, Krajinovic M, Sinnett D, Laverdière C, Sultan S. Contributing factors to well-being in a sample of long-term survivors of childhood acute lymphoblastic leukemia: the role of social support in emotional regulation. Health Psychol Behav Med 2024; 12:2301550. [PMID: 38239926 PMCID: PMC10795780 DOI: 10.1080/21642850.2023.2301550] [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: 06/28/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
Objectives: To understand why some long-term childhood cancer survivors experience positive adjustment in the long run,[Q1] this study aimed to (1) explore associations between well-being, health status, social support, and emotion regulation (ER) strategies in a cohort of long-term childhood lymphoblastic leukemia (cALL) survivors, (2) identify the individual contribution of each ER strategy to well-being (3) and their interaction with social support. Methods: We used data from 92 participants from the PETALE cohort (51% female, aged 24 ± 7 years). Measures included well-being (WHO-5), health status (15D), social support (SSQ-6), cognitive reappraisal and expressive suppression (ERQ), and emotional processing and expression (EAC). We modeled the odds of high well-being adjusting for health status in logistic regressions and explored the moderating role of social support with bootstrap techniques. Independent of clinical history, high well-being was associated with better health status, higher social support, more frequent use of cognitive reappraisal and emotional processing. Results: We found a main contribution of emotional processing to well-being (OR = 2.12, 95% CI = 1.09-5.37). The interaction between low suppression and high social support was significant (OR = .40, 95% CI = .13-.79). Probabilities for high well-being were 96% when expressive suppression was low and social support was high. Results suggest approaching one's own emotions may contribute to well-being in long-term childhood cancer survivors. Clinical implications: Combining curbing emotional suppression with promoting supportive social environment could be a promising target for future supportive care interventions in survivors.
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Affiliation(s)
- Camille Bourdeau
- Department of Psychology, Université de Montréal, Montreal, Canada
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Sarah Lippé
- Department of Psychology, Université de Montréal, Montreal, Canada
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Philippe Robaey
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Émélie Rondeau
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
| | - Maja Krajinovic
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
| | - Serge Sultan
- Department of Psychology, Université de Montréal, Montreal, Canada
- Research Centre, Sainte-Justine University Health Centre, Montreal, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Canada
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Oyedele OO, Phillips C, Robb SL. Spirituality in Adolescents and Young Adults With Cancer: An Evolutionary Concept Analysis. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:16-31. [PMID: 37853729 DOI: 10.1177/27527530231190375] [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: 10/20/2023]
Abstract
Background: Despite an increased focus on the importance of spirituality to human health, including adolescent health outcomes there remains an absence of evidence-based programs to address the spiritual needs of patients and families. A critical barrier is the absence of a clear conceptual understanding and operational definitions of spirituality for adolescents/young adults (AYAs) with cancer. The purposes of this concept analysis were to (a) clarify the concept of spirituality in the context of the AYAs' cancer experience and (b) generate a definition based on a review of the literature examining spiritual development and the role of spirituality in AYAs' health and cancer treatment. Method: We used Roger's evolutionary concept analysis method to identify antecedents, attributes, and consequences of spirituality in the context of AYAs' cancer using thematic analysis and included identification of case exemplars. Results: Of the 86 articles identified, 21 met our inclusion criteria. Analysis revealed four attributes of spirituality in AYAs with cancer: meaning and purpose, connectedness, life-long universal experience, and independent of or related to religion and faith traditions. Identified antecedents included the presence of spiritual resources, chronic illness, belief, or wonder about a higher power, and existential questions. Identified consequences included hope, meaning, feelings of peace, and enhanced well-being and illness acceptance. Based on the findings, we generated a definition of spirituality in AYAs with cancer. Discussion: Findings inform the development of measures and spiritual care interventions specific to AYAs with cancer. An important limitation to address in future research is the absence of AYAs' first-person accounts of their own spirituality.
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Affiliation(s)
| | | | - Sheri L Robb
- Indiana University School of Nursing, Indianapolis, IN, USA
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Winzig J, Inhestern L, Paul V, Nasse ML, Krauth KA, Kandels D, Rutkowski S, Escherich G, Bergelt C. Parent-reported health-related quality of life in pediatric childhood cancer survivors and factors associated with poor health-related quality of life in aftercare. Qual Life Res 2023; 32:2965-2974. [PMID: 37204653 PMCID: PMC10474174 DOI: 10.1007/s11136-023-03436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Despite advances in cancer treatment, there is a prevalence of pediatric childhood cancer survivors still at risk of developing adverse disease and treatment outcomes, even after the end of treatment. The present study aimed to (1) explore how mothers and fathers assess the health-related quality of life (HRQoL) of their surviving child and (2) evaluate risk factors for poor parent-reported HRQoL in childhood cancer survivors about 2.5 years after diagnosis. METHODS We assessed parent-reported HRQoL of 305 child and adolescent survivors < 18 years diagnosed with leukemia or tumors of central nervous system (CNS) with the KINDL-R questionnaire in a prospective observational study with a longitudinal mixed-methods design. RESULTS In agreement with our hypotheses, our results show that fathers rate their children's HRQoL total score as well as the condition-specific domains family (p = .013, d = 0.3), friends (p = .027, d = 0.27), and disease (p = .035, d = 0.26) higher than mothers about 2.5 years after diagnosis. Taking variance of inter-individual differences due to family affiliation into account, the mixed model regression revealed significant associations between the diagnosis of CNS tumors (p = .018, 95% CI [- 7.78, - 0.75]), an older age at diagnosis, (p = .011, 95% CI [- 0.96, - 0.12]), and non-participation in rehabilitation (p = .013, 95% CI [- 10.85, - 1.28]) with poor HRQoL in children more than 2 years after being diagnosed with cancer. CONCLUSION Based on the results, it is necessary for health care professionals to consider the differences in parental perceptions regarding children's aftercare after surviving childhood cancer. High risk patients for poor HRQoL should be detected early, and families should be offered support post-cancer diagnosis to protect survivors' HRQoL during aftercare. Further research should focus on characteristics of pediatric childhood cancer survivors and families with low participation in rehabilitation programs.
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Affiliation(s)
- Jana Winzig
- 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
| | - Verena Paul
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Mona L Nasse
- 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
| | - Daniela Kandels
- Swabian Children's Cancer Center, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, 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
- Department of Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany
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Tutelman PR, Chambers CT, Noel M, Heathcote LC, Fernandez CV, Flanders A, MacLeod J, Sherry SB, Simard S, Stern M, Stewart SH, Urquhart R. Pain and Fear of Cancer Recurrence in Survivors of Childhood Cancer. Clin J Pain 2022; 38:484-491. [PMID: 35686578 DOI: 10.1097/ajp.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity. METHODS The participants were 54 survivors of various childhood cancers (Mage=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR. RESULTS Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR2=0.11, P<0.01) and child (ΔR2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain. DISCUSSION The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one's anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.
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Affiliation(s)
- Perri R Tutelman
- Departments of Psychology and Neuroscience
- Centre for Pediatric Pain Research
| | - Christine T Chambers
- Departments of Psychology and Neuroscience
- Pediatrics
- Centre for Pediatric Pain Research
| | - Melanie Noel
- Department of Psychology
- Alberta Children's Hospital Research Institute, University of Calgary
- Hotchkiss Brain Institute, Calgary, AB
| | - Lauren C Heathcote
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Conrad V Fernandez
- Pediatrics
- Bioethics
- Division of Pediatric Hematology-Oncology, IWK Health Centre
| | | | | | | | - Sébastien Simard
- Département des sciences de la santé & Centre Intersectoriel en Santé Durable (CISD), Université du Québec à Chicoutimi (UQAC), Saguenay, QC
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The impact of CNS-directed treatment on quality of life in childhood cancer survivors. Qual Life Res 2022; 31:817-829. [PMID: 34455525 PMCID: PMC8882709 DOI: 10.1007/s11136-021-02984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Pediatric cancer survivors may have lower quality of life (QoL), but most research has assessed outcomes either in treatment or long-term survivorship. We focused on early survivorship (i.e., 3 and 5 years post-diagnosis), examining the impact of CNS-directed treatment on child QoL, as well as sex and age at diagnosis as potential moderators. METHODS Families of children with cancer (ages 5-17) were recruited at diagnosis or relapse (N = 336). Survivors completed the PedsQL at 3 (n = 96) and 5 years (n = 108), along with mothers (101 and 105, respectively) and fathers (45 and 53, respectively). The impact of CNS treatment, sex, and age at diagnosis on child QoL was examined over both time since diagnosis and time since last treatment using mixed model analyses. RESULTS Parent-report of the child's total QoL was in the normative range and stable between 3 and 5 years when examining time since diagnosis, while child reported QoL improved over time (p = 0.04). In terms of time since last treatment, mother and child both reported the child's QoL improved over time (p = 0.0002 and p = 0.0006, respectively). Based on parent-report, males with CNS-directed treatment had lower total QoL than females and males who did not receive CNS-directed treatment. Age at diagnosis did not moderate the impact of treatment type on total QoL. CONCLUSIONS Quality of life (QoL) in early survivorship may be low among males who received CNS-directed treatment. However, this was only evident on parent-report. Interventions to improve child QoL should focus on male survivors who received CNS-directed treatment, as well as females regardless of treatment type.
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7
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Manove EE, Poon CYS, Rhodes JE, Lowe SR. Changes in Psychosocial Resources as Predictors of Posttraumatic Growth: A Longitudinal Study of Low-Income, Female Hurricane Katrina Survivors. TRAUMATOLOGY 2021; 27:346-353. [PMID: 35356133 PMCID: PMC8962964 DOI: 10.1037/trm0000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study examined how well the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) corresponds with self-reported pre- to posttrauma changes in related constructs, including sense of purpose in life, religiosity, and social support. Participants were 328 low-income mothers (85.2% non-Hispanic Black) who survived Hurricane Katrina and completed surveys approximately 1 year predisaster (Time 1), 4 years postdisaster (Time 2), and 12 years postdisaster (Time 3). PTG was assessed at Time 2 and Time 3, and related constructs were assessed at all waves. Pre- to postdisaster changes in the following related constructs were significantly associated with the corresponding PTGI subscales: purpose in life with Relating to Others, Personal Strength, and New Possibilities; religiosity with Spiritual Change; and perceived social support with Relating to Others. The results demonstrate a link between a number of self-reported pre- to posttrauma psychological changes measured over time and the PTGI. Replication of these results using measures more closely aligned to the PTGI subscales, among more representative samples and in the aftermath of other traumatic events, is warranted.
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Affiliation(s)
- Emily E. Manove
- Department of Psychology, University of Massachusetts Boston
| | | | - Jean E. Rhodes
- Department of Psychology, University of Massachusetts Boston
| | - Sarah R. Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health
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Sylvest R, Vassard D, Schmidt L, Schmiegelow K, Macklon KT, Forman JL, Pinborg A. Family Formation and Socio-Economic Status among 35-Year-Old Men Who Have Survived Cancer in Childhood and Early Adulthood: A Register-Based Cohort Study. Oncol Res Treat 2021; 45:102-111. [PMID: 34823245 DOI: 10.1159/000520365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The number of children and young adults who survive cancer has steadily increased over the past decades. Consequently, life circumstances after cancer have gained increasing importance. The aim of this study was to explore family formation and socio-economic status among 35-year-old men having survived cancer in childhood or early adulthood compared to an age-matched comparison group. METHODS This study is a national, register-based cohort study among 35-year-old men. Men diagnosed with cancer in childhood and early adulthood were registered between 1978 and 2016. At the time of diagnosis, each patient was randomly matched with 150 men without cancer from the background population within the same birth year. Those still alive at the age of 35 years were included in the study population. RESULTS The study population consisted of 4,222 men diagnosed with cancer in childhood or early adulthood and 794,589 men in the age-matched comparison group. Men who have survived cancer during childhood or early adulthood have a reduced probability of having children, and lower probability of getting married or of cohabitation than those from an age-matched comparison group. Men who have survived CNS cancer also have a lower probability of having a higher education than high school and a higher probability of being outside the workforce than those from an age-matched comparison group. DISCUSSION/CONCLUSION Many men who have survived cancer during childhood or early adulthood are influenced by their cancer later in life, which was apparent in family formation, educational achievements, and labour market attachment. Continued focus on rehabilitation and needs for support among the male survivors of childhood and youth cancer is warranted.
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Affiliation(s)
- Randi Sylvest
- Department of Obstetrics and Gynaecology, Fertility Clinic Section 455, Hvidovre University Hospital, Hvidovre, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Tryde Macklon
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julie Lyng Forman
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Fisher AP, Patronick J, Gerhardt CA, Radonovich K, Salloum R, Wade SL. Impact of COVID-19 on adolescent and emerging adult brain tumor survivors and their parents. Pediatr Blood Cancer 2021; 68:e29116. [PMID: 34028992 PMCID: PMC8209896 DOI: 10.1002/pbc.29116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has prompted unprecedented challenges, contributing to greater difficulties among families of children with special health care needs, such as pediatric brain tumor survivors. We examined the impact of the pandemic on psychosocial functioning of adolescent and emerging adult survivors and their parents. We hypothesized that COVID-19 disruptions and survivor social connectedness would be associated with survivor-reported posttraumatic stress and family outcomes, including family functioning, parenting, and parent mental health. PROCEDURE Fifty-five families (44 survivors, 48 parents) were recruited via phone and email to participate in the study. Survivors were ages 13-25 (M = 19.62, SD = 3.47) and at least 5 years post diagnosis. Parents completed the COVID-19 Exposure and Family Impact Survey (CEFIS), and survivors completed the Environmental influences on Child Health Outcomes (ECHO) COVID-19 child self-report form, which assessed pandemic impacts on their psychosocial functioning. RESULTS Parents reported a mean of 7.52 (SD = 2.83) disruptions to their families' lives. The pandemic negatively affected survivors' life satisfaction (Mdiff = 0.46, t(44) = 3.96, p < .001), with 92% reporting reduced social connectedness (n = 39). Total disruptions due to COVID-19 and survivor social connectedness predicted survivor-reported posttraumatic stress, above and beyond survivors' pre-pandemic psychosocial risk. Most parents reported positive changes in their parenting (n = 31, 67.4%) and family cohesion (n = 30, 66.7%). However, they also reported worsened mood (n = 28, 62.3%) and increased anxiety (n = 31, 71.1%). CONCLUSIONS Parents and survivors reported positive and negative impacts of COVID-19, which had downstream consequences on survivor psychosocial functioning. Follow-up care should consider potential adverse effects on social connectedness and stress symptoms.
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Affiliation(s)
- Allison P. Fisher
- Division of Physical Medicine and RehabilitationCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jamie Patronick
- Division of Physical Medicine and RehabilitationCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Cynthia A. Gerhardt
- Center for Biobehavioral HealthAbigail Wexner Research Institute at Nationwide Children's HospitalColumbusOhioUSA,Departments of Pediatrics and PsychologyThe Ohio State UniversityColumbusOhioUSA
| | - Krestin Radonovich
- Department of Physical Medicine and RehabilitationUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ralph Salloum
- Neuro‐Oncology Program, Division of Hematology, Oncology & Bone Marrow TransplantNationwide Children's Hospital, The Ohio State UniversityColumbusOhioUSA
| | - Shari L. Wade
- Division of Physical Medicine and RehabilitationCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA,Department of PediatricsUniversity of CincinnatiCincinnatiOhioUSA
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10
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Fear of Cancer Recurrence and Death Anxiety: Unaddressed Concerns for Adult Neuro-oncology Patients. J Clin Psychol Med Settings 2021; 28:16-30. [PMID: 31848927 DOI: 10.1007/s10880-019-09690-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Primary brain tumor (PBT) patients may experience existential distress; however, few studies have examined this issue. The objectives of this study were to (1) systematically review PBT representation in psycho-oncology literature regarding fear/anxiety related to progression, recurrence, and death and (2) preliminarily assess the prevalence of fear of dying in a sample of PBT patients. Systematic searching of three databases yielded 1555 articles for review. Of these, 327 studies met inclusion criteria (patient sample N = 132,951). Only eight studies (0.18% of the participants) included patients with a PBT diagnosis, potentially due to exclusion criteria such as cognitive impairment or specific treatment parameters which may prohibit PBT patient participation. Review of the results from the eight included studies revealed mixed methods and limited demographic analyses; existential distress was correlated with heightened depression and anxiety, and overall worsened quality of life. From the original data collection, approximately one-third of PBT patients endorsed fear of dying, which was positively related to depression severity. Taken together, results suggest that PBT patients are considerably underrepresented in existential psycho-oncology literature, despite preliminary findings suggesting prevalence of these concerns. Future research on existential distress in neuro-oncology is warranted.
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11
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Fisher RS, Sharp KMH, Prussien KV, Himelhoch AC, Murphy LK, Rodriguez EM, Young-Saleme TK, Vannatta K, Compas BE, Gerhardt CA. Coping Trajectories and the Health-Related Quality of Life of Childhood Cancer Survivors. J Pediatr Psychol 2021; 46:960-969. [PMID: 33738496 DOI: 10.1093/jpepsy/jsab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify coping trajectories from diagnosis through survivorship and test whether particular trajectories exhibit better health-related quality of life (HRQOL) at 5 years post-diagnosis. METHODS Families of children with cancer (ages 5-17; M = 10.48, SD = 4.03) were recruited following a new diagnosis of cancer (N = 248). Three follow-up assessments occurred at 1-year (N = 185), 3-years (N = 101), and 5-years (N = 110). Mothers reported on children's coping using the Responses to Stress Questionnaire for Pediatric Cancer. Survivor HRQOL was measured at 5-year follow-up using self-report on the PedsQL 4.0. Longitudinal patterns of coping were derived using Latent Class Growth Analysis and mean-levels of survivor-report HRQOL were compared across classes. RESULTS Two primary control coping trajectories emerged, "Moderate and Stable" (50%) and "Low-moderate and Decreasing" (50%), with no significant differences in HRQOL across trajectories. Three secondary control coping trajectories emerged, "Moderate-high and Increasing" (54%), "Moderate and Stable" (40%), and "High and Increasing" (6%), with survivors in the last trajectory showing better HRQOL. Two disengagement coping trajectories emerged, "Low and Stable" (85%) and "Low and Variable" (15%), with no significant differences in HRQOL across trajectories. CONCLUSIONS Coping trajectories were relatively stable from diagnosis to 5 years. A small group of survivors with high and increasing secondary control coping over time, per mother-report, reported better HRQOL. Future research should consider tailoring coping interventions to children with cancer to improve survivors' HRQOL.
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Affiliation(s)
- Rachel S Fisher
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Katianne M Howard Sharp
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Kemar V Prussien
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Alexandra C Himelhoch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Lexa K Murphy
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Erin M Rodriguez
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX
| | | | - Kathryn Vannatta
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University, Columbus, OH.,Department of Psychology, The Ohio State University, Columbus, OH
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University, Columbus, OH.,Department of Psychology, The Ohio State University, Columbus, OH
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de Castro EK, Crespo C, Barros L, Armiliato MJ, Gregianin L. Assessing the Relationship between PTSS in Childhood Cancer Survivors and Their Caregivers and Their Quality of Life. Pediatr Hematol Oncol 2021; 38:147-153. [PMID: 33000978 DOI: 10.1080/08880018.2020.1825574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Childhood cancer is a traumatic experience for survivors and their families. The experience of this disease affects survivors' and families' quality of life, even years after it occurs. The purpose of the present study was to assess if the caregivers' posttraumatic stress symptoms mediated the associations between survivors' posttraumatic stress symptoms and caregivers' quality of life, in a sample of 46 dyads of caregivers and childhood cancer survivors. Survivors and caregivers completed the PCL-5, and caregivers completed the WHOQOL-bref. Results showed that survivors' and caregivers' posttraumatic stress symptoms scores and caregivers' quality of life were associated. The caregivers' posttraumatic stress symptoms mediated the relationship between survivors' posttraumatic stress symptoms and caregivers' quality of life. Knowing posttraumatic stress symptoms direct and indirect effects on caregivers' quality of life contributes to understand their experience and to develop intervention strategies with this population.
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Affiliation(s)
- Elisa Kern de Castro
- Instituto de Psicologia e Ciências da Educação, Universidade Lusíada de Lisboa, Lisboa, Portugal
| | - Carla Crespo
- Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Luísa Barros
- Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Maria Júlia Armiliato
- Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos, Sao Leopoldo, Brazil
| | - Lauro Gregianin
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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13
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Perceived Health among Adolescent and Young Adult Survivors of Childhood Cancer. ACTA ACUST UNITED AC 2021; 28:825-836. [PMID: 33562251 PMCID: PMC7985790 DOI: 10.3390/curroncol28010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
Survivors of childhood cancer (SCCs) are at increased risk of late effects, which are cancer- and treatment-related side-effects that are experienced months to years post-treatment and encapsulate a range of physical, cognitive and emotional problems including secondary malignancies. Perceived health can serve as an indicator of overall health. This study aims to (1) understand how a patient reported outcome (PRO) of perceived health of SCCs compares to controls who have not had a cancer diagnosis and (2) examine the relationships between perceived health and demographic and clinical variables, and health behavior. A total of 209 SCCs (n = 113 (54.10%) males; median age at diagnosis = 6.50 years; median time off treatment = 11.10 years; mean age at study = 19.00 years) were included. SCCs completed annual assessments as part of Long-Term Survivor Clinic appointments, including a question on perceived health answered on a five-point Likert scale. Data were collected retrospectively from medical charts. Perceived health of SCCs was compared to a control group (n = 836) using data from the 2014 Canadian Community Health Survey. Most SCCs (67%) reported excellent or very good health. The mean perceived health of SCCs (2.15 ± 0.91) was not statistically different from population controls (2.10 ± 0.87). Pain (B = 0.35; p < 0.001), physical activity (B = −0.39; p = 0.013) and concerns related to health resources (B = 0.59; p = 0.002) were significant predictors of perceived health. Factors shown to influence SCCs’ perceived health may inform interventions. Exploration into how SCCs develop their conception of health may be warranted.
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14
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Werk RS, Steinhorn DM, Newberg A. The Relationship Between Spirituality and the Developing Brain: A Framework for Pediatric Oncology. JOURNAL OF RELIGION AND HEALTH 2021; 60:389-405. [PMID: 32270366 DOI: 10.1007/s10943-020-01014-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Development, whether motor, language, social, or spiritual, is the functional expression of complex brain processes throughout one's life span, the foundations of which are laid in childhood. The effects of cancer, chemotherapy, radiation, and surgical procedures on early brain development have been measured using neuroimaging and developmental assessment tools. We propose that spiritual development may be substantially affected in children with oncological diseases that impact underlying brain processes. By drawing connections between science, spirituality, and medicine, we can better address the spiritual needs of children as they cope with oncological diseases, by mitigating emotional, cognitive, and physical symptoms and improving outcomes.
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Affiliation(s)
- Rachel S Werk
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, 8161 DOT37232-9760, USA.
| | - David M Steinhorn
- Divisions of Pediatric Critical Care and Pediatric Palliative Care, Children's National Medical Center, Washington, DC, USA
| | - Andrew Newberg
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Recommendations for the surveillance of cancer-related fatigue in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. J Cancer Surviv 2020; 14:923-938. [PMID: 32839902 PMCID: PMC7572340 DOI: 10.1007/s11764-020-00904-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) negatively affects the lives of childhood, adolescent, and young adult (CAYA) cancer survivors. We aimed to provide an evidence-based clinical practice guideline (CPG) with internationally harmonized CRF surveillance recommendations for CAYA cancer survivors diagnosed < 30 years. METHODS This CPG was developed by a multidisciplinary panel under the umbrella of the International Late Effects of Childhood Cancer Guideline Harmonization Group. After evaluating concordances and discordances of four existing CPGs, we performed systematic literature searches. We screened articles for eligibility, assessed quality, extracted, and summarized the data from included articles. We formulated recommendations based on the evidence and clinical judgment. RESULTS Of 3647 articles identified, 70 articles from 14 countries were included. The prevalence of CRF in CAYA cancer survivors ranged from 10-85%. We recommend that healthcare providers are aware of the risk of CRF, implement regular screening with validated measures, and recommend effective interventions to fatigued survivors. CONCLUSIONS A considerable proportion of CAYA cancer survivors suffers from CRF even years after the end of treatment. IMPLICATIONS FOR CANCER SURVIVORS We recommend that healthcare providers adopt regular screening to detect and treat CRF early and positively influence survivors' health and quality of life.
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16
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Cohen J, Collins L, Gregerson L, Chandra J, Cohn RJ. Nutritional concerns of survivors of childhood cancer: A "First World" perspective. Pediatr Blood Cancer 2020; 67 Suppl 3:e28193. [PMID: 31994836 DOI: 10.1002/pbc.28193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Abstract
Childhood cancer survivor (CCS) numbers are increasing as a result of advances in both treatment and supportive care. This positive outcome is tempered by the recognition of a high burden of chronic health conditions. Here, we review the nutritional concerns of CCS, including dietary habits after treatment and the factors during treatment that may contribute to chronic health conditions. Dietary interventions that have been conducted in CCS will be summarized along with focused goals of these interventions. We will also address the need to leverage these interventions to reduce the risk of chronic disease in CCS.
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Affiliation(s)
- Jennifer Cohen
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia
| | - Laura Collins
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Laura Gregerson
- Department of Nutrition, Exercises and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Joya Chandra
- Departments of Pediatrics Research, Epigenetics and Molecular Carcinogenesis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard J Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Randwick, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
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17
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van Deuren S, Boonstra A, van Dulmen‐den Broeder E, Blijlevens N, Knoop H, Loonen J. Severe fatigue after treatment for childhood cancer. Cochrane Database Syst Rev 2020; 3:CD012681. [PMID: 32124971 PMCID: PMC7059965 DOI: 10.1002/14651858.cd012681.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment strategies for childhood cancer are improving, resulting in higher survival rates. However, the consequences of childhood cancer do not end with the successful completion of cancer treatment. Most patients will develop late effects after cessation of treatment. Severe fatigue is seen as a common and debilitating late effect in cancer survivors. Although most research on fatigue has been performed in patients after adult-onset cancer, our review focuses on fatigue after childhood cancer. OBJECTIVES To estimate the prevalence of severe fatigue after treatment for childhood cancer. Secondary objectives are to describe the course of severe fatigue following cancer treatment and to examine risk factors for fatigue, or factors associated with it. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019; issue 8 March 2019), MEDLINE/PubMed (from 1945 to 8 March 2019), Embase/Ovid (from 1947 to 8 March 2019), reference lists of included articles and several conference proceedings from 2011 to 2018. SELECTION CRITERIA Observational studies, randomised controlled trials and controlled clinical trials reporting on fatigue in participants after treatment for childhood cancer. Case series and case reports were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risks of bias. If the publication did not present the prevalence of severe fatigue, we contacted study authors for additional information. MAIN RESULTS We included 30 studies (18,682 participants in total). Eighteen studies contributed to the main objective and 22 studies contributed to the secondary objectives. We found substantial differences between studies in cancer diagnosis, cancer treatment, age of participants, questionnaires used to assess fatigue, and sample size. All included studies scored at least one 'Risk of bias' item as unclear or high risk. We identified both clinical and statistical heterogeneity and therefore could not pool results, so we present them descriptively. Eighteen studies (describing 14,573 survivors) reported the prevalence of severe fatigue, which ranged from 0% to 61.7%. In a subgroup of three studies including children aged up to 18 years at fatigue assessment (268 survivors), prevalence rates ranged from 6.7% to 12.5%. In comparison, in a subgroup of 12 studies including participants aged 16 and over (13,952 survivors), prevalence rates ranged from 4.4% to 61.7%. The prevalence of severe fatigue in a subgroup of survivors of haematological cancer was presented in seven studies and ranged from 1.8% to 35.9% (1907 survivors). Prevalence of severe fatigue in brain cancer survivors was presented in two studies (252 survivors) and was 14.6% and 21.1% respectively. One study presented a prevalence for bone cancer survivors of 0.0% (17 survivors). Four studies provided prevalence rates of severe fatigue in control groups of siblings or population-based controls, which ranged from 3.1% to 10.3%. In these four studies, survivors were more often fatigued than controls, but this difference was statistically significant in only two studies. Studies assessing risk and associated factors for fatigue were heterogeneous, and definitions of the factors under study were often inconsistent, with results therefore presented descriptively. They found that depression might be associated with fatigue. In contrast, age at diagnosis and education level did not seem to be associated with fatigue. We were unable to calculate any overall risk estimate for any of the reported risks and associated factors, because we could not conduct meta-analysis. One study provided information about the course of fatigue over time, and found that over the course of 2.7 years, 32 of the 102 participants (31.4%) reported persistent severe fatigue. AUTHORS' CONCLUSIONS It is unclear how many childhood cancer survivors suffer from severe fatigue. This review encountered several difficulties. We found statistical and clinical heterogeneity and great variation in the reporting of possible risk and associated factors. The evidence in this review is therefore weak, and the exact prevalence of severe fatigue after treatment for childhood cancer remains to be determined. This is also the case for the course of severe fatigue following treatment and the strength of the relationship between fatigue and associated and risk factors. Despite these limitations, our review does provide a comprehensive overview of the existing literature about severe fatigue after treatment for childhood cancer.
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Affiliation(s)
- Sylvia van Deuren
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Hans Knoop
- Amsterdam UMC, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
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18
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Hypnosis for pain in pediatric oncology: relevant and effective or an intervention of the past? Pain 2020; 161:901-915. [PMID: 31895265 DOI: 10.1097/j.pain.0000000000001790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Bakula DM, Sharkey CM, Perez MN, Espeleta HC, Gamwell KL, Baudino M, Delozier AM, Chaney JM, Alderson RM, Mullins LL. The Relationship Between Parent Distress and Child Quality of Life in Pediatric Cancer: A Meta-Analysis. J Pediatr Nurs 2020; 50:14-19. [PMID: 31670136 DOI: 10.1016/j.pedn.2019.09.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022]
Abstract
PROBLEM Pediatric cancer places both parents and children at risk for psychosocial difficulties, including a specific risk for diminished quality of life. Previous research has identified relationships between parent and child psychosocial adjustment outcomes (e.g., depression, anxiety), yet the relationships between parent adjustment and child quality of life have yet to be comprehensively evaluated via meta-analysis. ELIGIBILITY CRITERIA A systematic review and meta-analysis were conducted using EBSCO, with PsychINFO, MEDLINE, Academic Search Premiere, and Health Source: Nursing/Academic Edition. SAMPLE Fourteen studies met inclusion criteria. RESULTS Fourteen correlations from 1646 parents of children with cancer were evaluated, resulting in a medium-magnitude correlation between parent psychosocial adjustment and child quality of life (r = 0.23, p < .001). Additional analyses evaluating the relationship between parent psychosocial adjustment and child social/emotional quality of life resulted in a medium-magnitude correlation (r = 0.24, p < .001). CONCLUSIONS A significant relationship exists between parent psychosocial adjustment and child quality of life. However, this relationship appears slightly less strong than those found in meta-analyses evaluating other child psychosocial adjustment outcomes. IMPLICATIONS Parent distress is an important factor to evaluate in the context of pediatric cancer, as it appears to have implications for child quality of life, in addition to other child psychosocial adjustment outcomes.
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Affiliation(s)
- Dana M Bakula
- Department of Psychology, Oklahoma State University, United States of America.
| | - Christina M Sharkey
- Department of Psychology, Oklahoma State University, United States of America
| | - Megan N Perez
- Department of Psychology, Oklahoma State University, United States of America
| | - Hannah C Espeleta
- Department of Psychology, Oklahoma State University, United States of America
| | - Kaitlyn L Gamwell
- Department of Psychology, Oklahoma State University, United States of America
| | - Marissa Baudino
- Department of Psychology, Oklahoma State University, United States of America
| | | | - John M Chaney
- Department of Psychology, Oklahoma State University, United States of America
| | - R Matt Alderson
- Department of Psychology, Oklahoma State University, United States of America
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, United States of America
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20
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Schulte F, Patton M, Alberts NM, Kunin-Batson A, Olson-Bullis BA, Forbes C, Russell KB, Neville A, Heathcote LC, Karlson C, Racine N, Charnock C, Hocking MC, Banerjee P, Tutelman P, Noel M, Krull KR. Pain in long-term survivors of childhood cancer: A systematic review of the current state of knowledge and a call to action from the Children's Oncology Group. Cancer 2020; 127:35-44. [PMID: 33112416 PMCID: PMC7875461 DOI: 10.1002/cncr.33289] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
Survivors of childhood cancer may be at risk of experiencing pain, and a systematic review would advance our understanding of pain in this population. The objective of this study was to describe: 1) the prevalence of pain in survivors of childhood cancer, 2) methods of pain measurement, 3) associations between pain and biopsychosocial factors, and 4) recommendations for future research. Data sources for the study were articles published from January 1990 to August 2019 identified in the PubMed, PsycINFO, EMBASE, and Web of Science data bases. Eligible studies included: 1) original research, 2) quantitative assessments of pain, 3) articles published in English, 4) cancers diagnosed between birth and age 21 years, 5) survivors at 5 years from diagnosis and/or at 2 years after therapy completion, and 6) a sample size >20. Seventy-three articles were included in the final review. Risk of bias was considered using the Cochrane risk of bias tool. The quality of evidence was evaluated according to Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria. Common measures of pain were items created by the authors for the purpose of the study (45.2%) or health-related quality-of-life/health status questionnaires (42.5%). Pain was present in from 4.3% to 75% of survivors across studies. Three studies investigated chronic pain according the definition in the International Classification of Diseases. The findings indicated that survivors of childhood cancer are at higher risk of experiencing pain compared with controls. Fatigue was consistently associated with pain, females reported more pain than males, and other factors related to pain will require stronger evidence. Theoretically grounded, multidimensional measurements of pain are absent from the literature.
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Affiliation(s)
- Fiona Schulte
- University of Calgary, Calgary, AB, Canada,Alberta Children’s Hospital, Calgary, AB, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Matthew C. Hocking
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA,University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Melanie Noel
- University of Calgary, Calgary, AB, Canada,Alberta Children’s Hospital, Calgary, AB, Canada
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21
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Shunmugasundaram C, Elangovan V, Radhakrishnan V. Construction and validation of a quality of life tool for pediatric patients of Indian origin with cancer: A single-center prospective study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_191_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Kelada L, Wakefield CE, Heathcote LC, Jaaniste T, Signorelli C, Fardell JE, Donoghoe M, McCarthy MC, Gabriel M, Cohn RJ. Perceived cancer-related pain and fatigue, information needs, and fear of cancer recurrence among adult survivors of childhood cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:2270-2278. [PMID: 31257099 DOI: 10.1016/j.pec.2019.06.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Pain and fatigue are under-researched late effects of childhood cancer and its treatment, and may be interpreted by survivors as indicating cancer recurrence. Moreover, unmet information needs for managing pain and fatigue may be related to fear of cancer recurrence. We investigated the complex relationships between perceived cancer-related pain and fatigue, unmet information needs for managing pain and fatigue, and fear of cancer recurrence. METHODS We surveyed 404 adult survivors of any form of childhood cancer (M = 16.82 years since treatment completion). RESULTS Many survivors reported perceived cancer-related pain (28.7%) and fatigue (40.3%), and anticipated future pain (19.3%) and fatigue (26.2%). These symptomologies were all related to unmet information needs for managing pain (18.8%) and fatigue (32.2%; all p's<.001). Survivors reporting unmet information needs for managing pain (B = .48, 95% CI = 0.19-0.76, p = .001) and fatigue (B = .32, 95% CI = 0.06-0.52, p = .015) reported higher fear of cancer recurrence than survivors reporting no information needs. CONCLUSION Survivors often have unmet information needs for managing pain and fatigue, and these unmet needs are related to fear of cancer recurrence. PRACTICE IMPLICATIONS Long-term follow-up clinics should assess pain and fatigue. Information provision about pain and fatigue may be an important tool to help manage fear of cancer recurrence.
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Affiliation(s)
- L Kelada
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia.
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - L C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Palo Alto, USA
| | - T Jaaniste
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Department of Pain & Palliative Care, Sydney Children's Hospital, High Street, Randwick, Australia
| | - C Signorelli
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - J E Fardell
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
| | - M Donoghoe
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - M C McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - M Gabriel
- Cancer Centre for Children, The Children's Hospital, Westmead, Australia
| | - R J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, Australia
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23
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Bult MK, van Bindsbergen KLA, Schepers SA, de Ridder-Sluiter HG, Verhaak CM, van Litsenburg RRL, Merks JHM, van Noesel MM, Grootenhuis MA. Health-Related Quality of Life of Adolescents with Cancer During the First Year of Treatment. J Adolesc Young Adult Oncol 2019; 8:616-622. [PMID: 31268387 DOI: 10.1089/jayao.2019.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: Adolescents with cancer (aged 12-18 years) are at risk for impaired health-related quality of life (HRQoL). Little is known about this population during treatment. This study aimed to (1) determine the HRQoL of adolescents with cancer during the first year of treatment and compare them with age-matched peers and (2) obtain insight into cancer-specific HRQoL of adolescents during the first year of treatment. Methods: Participants were part of a larger study focused on routine monitoring of electronic reported outcomes in standard pediatric oncology care. Adolescents completed the pediatric quality of life inventory (PedsQL) 4.0 and the PedsQL Cancer Module 3.0. Mean generic HRQoL scale scores were compared between the groups using multivariate analysis of covariance. Cancer-specific item scores were dichotomized and percentages were calculated to determine the proportion of adolescents reporting presence or absence of problems. Results: A total of 73 (mean [M]age = 14.71, standard deviation [SD] = 1.85) adolescents with cancer (Mage = 14.71, SD = 1.85, Mtimesincediagnosis = 3.51 months, SD = 2.8) and 268 healthy peers (Mage = 14.23, SD = 1.51) participated. Adolescents with cancer reported significantly lower generic HRQoL scores on all domains than their peers (p's <0.05, η2 = 0.01-0.42). Most frequently reported cancer-specific HRQoL problems were pain (hurt joint/muscle, 42.9%), nausea (during medical treatments [47.1%]; food not tasting good [54.3%]; food and smells [61.4%]), worry (about relapse [45.7%]; about side effects [52.9%]), cognitive problems (paying attention [47.1%]), and physical appearance (not good looking [47.1%]). Conclusions: Adolescents with cancer showed impaired HRQoL during treatment on both physical and psychosocial domains. Close monitoring of physical and psychosocial symptoms during treatment is, therefore, important.
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Affiliation(s)
- Maureen K Bult
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Sasja A Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | | | - Chris M Verhaak
- Amalia Children's Hospital/Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raphaële R L van Litsenburg
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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24
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Physical Fitness of School-Age Children after Cancer Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081436. [PMID: 31018493 PMCID: PMC6518261 DOI: 10.3390/ijerph16081436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 01/28/2023]
Abstract
The aim of the study was to assess physical fitness of school-age children after cancer treatment. The study was comprised of one hundred and fifty six children-children after cancer treatment (n = 71, mean age 11.22 ± 3.11 years) vs. healthy children previously untreated for cancer (n = 85, mean age 10.71 ± 1.22 years). Physical fitness was assessed indirectly based on a ball throw (assessment of strength, coordination, and upper limb speed), long jump (assessment of jumping ability, speed, and coordination), and a 60 m run (assessment of speed). The analysis was performed based on the Student's t-test for independent samples and the analysis of variance and the post-hoc least significant difference test (LSD test). Children from the study group threw the ball closer and had shorter long jump performance compared to the control group, i.e., 12.93 [m] vs. 19.79 [m], respectively (p < 0.001) and 2.46 [m] vs. 2.70 [m], respectively (p = 0.02). However, their mean running time was longer, i.e., 13.33 [s] vs. 11.73 [s], respectively (p = 0.01). Division according to sex showed additionally significantly shorter ball throw distance in the study group in both girls (p = 0.001) and boys (p < 0.001), significantly shorter jump length in the group of girls (p = 0.01), and significantly longer running time in the group of boys (p = 0.04). Children treated for cancer are characterized by decreased physical fitness, and motor ability is sex-dependent. Both groups showed decreased strength, coordination, and upper limb speed. Additionally, worse jumping ability was found in girls whereas decreased speed was observed in boys.
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Development and validation of self- and caregiver-report of a distress screening tool for pediatric cancer survivors. Support Care Cancer 2019; 27:4179-4187. [PMID: 30805727 DOI: 10.1007/s00520-019-04708-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To develop and validate the Distress Screening Tool (DST) for child and adolescent cancer survivors. METHODS In part 1, items of the DST were generated through literature search and group interviews. Initially, the DST was tested on pediatric cancer survivors and their caregivers. In part 2, the modified version of the DST was retested with a different set of participants. Lastly, the psychometric properties and cutoff scores of the DST were evaluated on a separate set of survivors and caregivers. RESULTS In part 1, six items of the DST self- and caregiver-report versions were generated. The initial 6 DST items of both versions showed acceptable internal consistency, but low inter-item correlation. Following the item modification, both versions of the DST showed improved inter-item correlation. In part 2, the modified DST had acceptable internal consistency and convergent validity, with acceptable psychometric properties. Cutoff scores were also generated. CONCLUSIONS The DST could be a useful tool for pediatric cancer survivors.
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Yang Y, Li W, Wen Y, Wang H, Sun H, Liang W, Zhang B, Humphris G. Fear of cancer recurrence in adolescent and young adult cancer survivors: A systematic review of the literature. Psychooncology 2019; 28:675-686. [PMID: 30703261 DOI: 10.1002/pon.5013] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/16/2019] [Accepted: 01/25/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The current systematic review aims to provide an overview of fear of cancer recurrence (FCR) in adolescent and young adult cancer survivors (15-39 years at cancer diagnosis, AYAs). METHODS MEDLINE, PubMed, PsycINFO, and Embase databases were independently searched to identify relevant quantitative articles. PRISMA systematic review procedures were followed with quality assessment. RESULTS Seventeen studies were included in the current review. All were quantitative studies that utilized a cross-sectional study design. Seven articles reported results of FCR prevalence, six studied determinants related to FCR, and 11 articles provided information about consequences of FCR. Prevalence of FCR ranged from 31% to 85.2% among AYA survivors. Associations between sociodemographic/clinical variables and FCR were inconsistent. Psychological distress and higher treatment intensity were positively associated with higher FCR levels. Lower scores on levels of physical, psychological functioning, and overall health-related quality of life (QoL) were identified as consequences of increased FCR. CONCLUSION FCR appears to be a prevalent concern among adolescent and young adult cancer populations. Adequate assessment to determine need for support and intervention is still required. Longitudinal studies in AYAs are warranted to understand the development and potential influence of FCR. Age-appropriate and flexible psychological care would be more successful potentially with this crucial background information.
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Affiliation(s)
- Yuan Yang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Wen Li
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau SAR, China
| | - Yunhong Wen
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Hongmei Wang
- Department of Radiotherapy, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Hengwen Sun
- Department of Radiotherapy, Cancer Centre, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Weijiang Liang
- Department of Oncology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Bin Zhang
- Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Gerry Humphris
- School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, UK
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Weinstein AG, Henrich CC, Armstrong GT, Stratton KL, King TZ, Leisenring WM, Krull KR. Roles of positive psychological outcomes in future health perception and mental health problems: A report from the Childhood Cancer Survivor Study. Psychooncology 2018; 27:2754-2760. [PMID: 30189119 DOI: 10.1002/pon.4881] [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: 12/06/2017] [Revised: 06/25/2018] [Accepted: 07/30/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Positive psychological outcomes among adolescent and young adult survivors of childhood cancer may influence long-term health status. We examined posttraumatic growth (PTG) and Life satisfaction (LS) in adolescence, and their impact on future emotional and physical health status in young adulthood. METHODS Survivors (n = 2802) from the Childhood Cancer Survivor Study were longitudinally analyzed across social, emotional, and physical factors during adolescence (12-17 years old), and PTG (PTG-Inventory) and LS (Cantril-Ladder-of-Life) during young adulthood (19-24 years old). The impact of PTG and LS on survivors' future long-term mental health, physical health, and social skills was also examined (23-28 years old) using Structural Equation Modeling. RESULTS Survivors reported high levels of LS (M = 7.43, range 1 to 10) and a positive impact from their cancer experience (M = 48.78, range 0 to 105). Adolescent predictors of higher PTG included older age at diagnosis (p = 0.001), experiencing more severe chronic health conditions (p = 0.01), cancer recurrence/relapse (p = 0.01), and being diagnosed with a non-CNS cancer (p = 0.001). Higher perceived general health (p = 0.01), higher social skills (p = 0.001), and diagnosis with a non-CNS cancer (p = 0.02) were associated with higher LS. Higher PTG during young adulthood predicted poorer perceived health (p = 0.04) and worse emotional health (p = 0.001) in later adulthood. Higher LS predicted better emotional health (p = 0.001) and better perceived health (p = 0.001). CONCLUSIONS While LS was found to help survivors have better perceived long-term emotional and physical health outcomes, survivors with higher PTG fond both positive and negative impacts from cancer. Future therapeutic trials to improve LS should be considered.
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Affiliation(s)
| | | | - Gregory T Armstrong
- St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, USA
| | | | | | | | - Kevin R Krull
- St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, USA
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Bell H, Ownsworth T, Lloyd O, Sheeran N, Chambers S. A systematic review of factors related to children's quality of life and mental health after brain tumor. Psychooncology 2018; 27:2317-2326. [PMID: 30071150 DOI: 10.1002/pon.4850] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Brain tumor has been found to have a major impact on children's quality of life (QOL); yet, the subjective impact of the illness is still not well understood. This review aimed to investigate factors related to children's subjective well-being (SWB), or self-reported QOL and mental health after brain tumor. A further aim was to determine the consistency between child and parent-proxy ratings of children's SWB and common factors associated with both child and parent-proxy ratings. METHODS A systematic search of PsycINFO, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and Scopus was conducted from 1980 to May 2018 to identify eligible studies. Methodological quality of these studies was assessed by 2 independent reviewers. RESULTS Twenty studies investigated factors related to children's self-reported mental health or QOL. Fourteen studies examined these factors from the perspectives of both children and their parents. Overall, risk factors for poor QOL included infratentorial tumors, radiation, hydrocephalus, lower IQ, and behavioral problems. Only 5 studies examined mental health outcomes, the findings of which were mixed. Relatively few studies examined psychosocial variables related to children's SWB. CONCLUSIONS Although several risk factors for poor QOL were identified, further research investigating mental health outcomes and the influence of psychosocial factors on children's SWB is needed to guide support interventions for pediatric brain tumor.
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Affiliation(s)
- Hayley Bell
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Owen Lloyd
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Sheeran
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Suzanne Chambers
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Cancer Council Queensland, Brisbane, Queensland, Australia
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Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies. Blood 2018; 132:385-392. [DOI: 10.1182/blood-2017-11-778555] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/05/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
Adolescents and young adults (AYAs) occupy a unique place within the hematologic malignancy community due to the challenges they face related to their disease biology and physical, psychosocial, and economic circumstances, as well as issues related to access to care and long-term follow-up. Efforts to define age-specific (supportive) care needs and targets for intervention in these areas are evolving. This review discusses the psychosocial issues AYAs with hematologic malignancies are dealing with, how these might affect their health-related quality of life, and the challenges in delivering high-quality supportive care to this underserved population.
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Szentes A, Kökönyei G, Békési A, Bokrétás I, Török S. Differences in illness perception between children with cancer and other chronic diseases and their parents. Clin Child Psychol Psychiatry 2018; 23:365-380. [PMID: 28990411 DOI: 10.1177/1359104517731899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to explore the differences in illness perception between children with cancer and other chronic diseases. A secondary aim was to examine the similarities and differences between the illness perception of these children and their parents. METHODS The Revised Illness Perception Questionnaire (IPQ-R) was used to measure the children's and parents' illness perceptions. In this study, 184 children (ages 8-18 years) and their caregivers completed the questionnaires. RESULTS This study shows that children with cancer feel that they have greater control over their treatment compared to the other two groups. The children's parents have more pessimistic views of the illness than their children. CONCLUSION Examinations of illness perceptions among paediatric cancer patients and their families are essential in designing psychosocial interventions for these families. The clinical value of our results can help better understand the cancer-specific features of illness perceptions.
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Affiliation(s)
| | - Gyöngyi Kökönyei
- 2 Institute of Psychology, Eötvös Loránd University, Hungary.,3 MTA-SE-NAP B Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Hungary
| | - Andrea Békési
- 1 2nd Department of Paediatrics, Semmelweis University, Hungary.,4 Bátor Tábor Foundation, Hungary.,7 Novartis Hungary Ltd
| | - Ildikó Bokrétás
- 4 Bátor Tábor Foundation, Hungary.,5 Institute of Psychology, University of Pécs, Hungary
| | - Szabolcs Török
- 6 Institute of Mental Health, Semmelweis University, Hungary
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Marusak HA, Iadipaolo AS, Harper FW, Elrahal F, Taub JW, Goldberg E, Rabinak CA. Neurodevelopmental consequences of pediatric cancer and its treatment: applying an early adversity framework to understanding cognitive, behavioral, and emotional outcomes. Neuropsychol Rev 2018; 28:123-175. [PMID: 29270773 PMCID: PMC6639713 DOI: 10.1007/s11065-017-9365-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023]
Abstract
Today, children are surviving pediatric cancer at unprecedented rates, making it one of modern medicine's true success stories. However, we are increasingly becoming aware of several deleterious effects of cancer and the subsequent "cure" that extend beyond physical sequelae. Indeed, survivors of childhood cancer commonly report cognitive, emotional, and psychological difficulties, including attentional difficulties, anxiety, and posttraumatic stress symptoms (PTSS). Cognitive late- and long-term effects have been largely attributed to neurotoxic effects of cancer treatments (e.g., chemotherapy, cranial irradiation, surgery) on brain development. The role of childhood adversity in pediatric cancer - namely, the presence of a life-threatening disease and endurance of invasive medical procedures - has been largely ignored in the existing neuroscientific literature, despite compelling research by our group and others showing that exposure to more commonly studied adverse childhood experiences (i.e., domestic and community violence, physical, sexual, and emotional abuse) strongly imprints on neural development. While these adverse childhood experiences are different in many ways from the experience of childhood cancer (e.g., context, nature, source), they do share a common element of exposure to threat (i.e., threat to life or physical integrity). Therefore, we argue that the double hit of early threat and cancer treatments likely alters neural development, and ultimately, cognitive, behavioral, and emotional outcomes. In this paper, we (1) review the existing neuroimaging research on child, adolescent, and adult survivors of childhood cancer, (2) summarize gaps in our current understanding, (3) propose a novel neurobiological framework that characterizes childhood cancer as a type of childhood adversity, particularly a form of early threat, focusing on development of the hippocampus and the salience and emotion network (SEN), and (4) outline future directions for research.
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Affiliation(s)
- Hilary A Marusak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA.
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Felicity W Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
- Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Farrah Elrahal
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Elimelech Goldberg
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
- Kids Kicking Cancer, Southfield, MI, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Suite 2190, Detroit, MI, 48202, USA
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA
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Janin MMH, Ellis SJ, Wakefield CE, Fardell JE. Talking About Cancer Among Adolescent and Young Adult Cancer Patients and Survivors: A Systematic Review. J Adolesc Young Adult Oncol 2018; 7:515-524. [PMID: 29851370 DOI: 10.1089/jayao.2017.0131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Communication plays an essential role in social relationships. Yet it is unclear how young cancer patients and survivors communicate with peers, and whether this contributes to increased rates of social difficulties. We aimed to analyze how childhood cancer patients and survivors communicate about their cancer with family and peers. We systematically searched Medline, Embase and PsycINFO for peer-reviewed studies on cancer-related communication among patients and survivors (any cancer, <25 years at diagnosis). We screened 309 articles, and included 6 qualitative studies. Studies were assessed using a standardized quality assessment tool. Participants were adolescents and young adults, 16-34 years of age at the time of study. Included studies related to different forms of cancer-related communication, benefits, and challenges. We found that cancer-related communication was an individual, complex process, addressing medical, existential, and emotional aspects of cancer. Communication occurred on a spectrum with variation in who information was shared with, as well as differences in the frequency at which information was shared, and the amount and type of information shared. Communication often occurred at uncertain or significant times for participants, or was initiated by others. Communicating about cancer yielded benefits as a coping strategy, prompted social support, and appeared central to significant relationships. Barriers to communication, including fear of stigma and poor peer reactions, hindered willingness to disclose. The number of studies analyzing this topic was limited. Communicating about cancer is a significant yet complex process for young patients and survivors. Further research is needed to complement the existing literature and to establish the evidence base for the development of future effective interventions promoting social and communication skills.
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Affiliation(s)
- Madeleine Marie Hortense Janin
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
| | - Sarah Jane Ellis
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
| | - Claire Elizabeth Wakefield
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
| | - Joanna Elizabeth Fardell
- 1 Kids Cancer Center, Sydney Children's Hospital , Randwick, Australia .,2 School of Women's and Children's Health, Discipline of Pediatrics, UNSW Medicine, University of New South Wales , Sydney, Australia
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Park JL, Brandelli Y, Russell KB, Reynolds K, Li Y, Ruether D, Giese-Davis J. Unmet Needs of Adult Survivors of Childhood Cancers: Associations with Developmental Stage at Diagnosis, Cognitive Impairment, and Time from Diagnosis. J Adolesc Young Adult Oncol 2018; 7:61-71. [DOI: 10.1089/jayao.2017.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Joanne L. Park
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Yvonne Brandelli
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - K. Brooke Russell
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - Kathleen Reynolds
- Long Term Survivor's Clinic, Alberta Children's Hospital, Calgary, Canada
| | - Yong Li
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - Dean Ruether
- Alberta Health Services, Community Oncology, Calgary, Canada
| | - Janine Giese-Davis
- Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, Canada
- Alberta Health Services, Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
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Abate C, Lippé S, Bertout L, Drouin S, Krajinovic M, Rondeau É, Sinnett D, Laverdière C, Sultan S. Could we use parent report as a valid proxy of child report on anxiety, depression, and distress? A systematic investigation of father-mother-child triads in children successfully treated for leukemia. Pediatr Blood Cancer 2018; 65. [PMID: 29049860 DOI: 10.1002/pbc.26840] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Systematic assessment of emotional distress is recommended in after care. Yet, it is unclear if parent report may be used as a proxy of child report. The aim of this study was to assess agreements and differences and explore possible moderators of disagreement between child and parent ratings. METHODS Sixty-two young survivors treated for acute lymphoblastic leukemia (9-18 years) and both parents responded to the Beck Youth Inventory (anxiety and depression) and the distress rating scale on the child's status. Parents completed the Brief Symptom Inventory-18 on their own psychological status. Systematic analyses of agreement and differences were performed. RESULTS Mother-child and father-child agreements were fair on anxiety, depression, and distress (median intraclass correlation coefficient = 0.37). Differences between parents and children were medium sized (median d = 0.55) with parents giving higher scores than their children on anxiety, depression, and distress. Mothers reported distress more frequently than fathers (39 vs. 17%) when children reported none. The child being female and lower parental income were associated with lower agreement in fathers when rating child distress. Higher levels of parental psychological symptoms were consistently associated with lower agreement. CONCLUSIONS Parent-child differences when rating adolescent survivors' difficulties may be more important than previously thought. Parent report probably cannot be considered as a valid proxy of older child report on such internalized domains as anxiety, depression, or distress in the after-care clinic. Parents' report is also likely to be influenced by their own mood, a factor that should be corrected for when using their report.
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Affiliation(s)
- Cybelle Abate
- Sainte-Justine University Health Center, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Québec, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center, Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Québec, Canada
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Tonsing KN, Ow R. Quality of Life, Self-Esteem, and Future Expectations of Adolescent and Young Adult Cancer Survivors. HEALTH & SOCIAL WORK 2018; 43:15-21. [PMID: 29244117 DOI: 10.1093/hsw/hlx047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
Significant advancements in treatment modalities over the past few decades have significantly improved the survival rates of many types of childhood cancer, directing attention to the psychosocial consequences of successful treatment and subsequent survival. This study assesses quality of life (QoL) among survivors of childhood cancer. Data were collected by means of a survey questionnaire. Participants were assured of confidentiality and of the voluntary nature of participation. Participants ranged in age from 12 to 24 years (mean age = 17.2); 62 percent were male; 45.6 percent were in secondary grades (middle school or high school). Results showed that among the QoL domains, spiritual subscale ranked highest, and physical domain showed the lowest mean score. Self-esteem emerged as an important predictor for social domain of QoL. Cancer-specific worry emerged as a significant predictor for overall QoL. The findings suggest that survivors rated high on positive life changes and sense of purpose, which are associated with positive QoL. However, this was tempered by worries and uncertainty. This study provides seminal information on the psychosocial needs of childhood cancer survivors in an Asian context that can be used by health care professionals and providers to further promote support and health care following treatment.
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Affiliation(s)
- Kareen N Tonsing
- Kareen N. Tonsing, PhD, is assistant professor of social work, Department of Sociology, Anthropology, Social Work and Criminal Justice, Oakland University, 531 Varner Hall, 371 Varner Drive, Rochester, MI 48309; e-mail: . Rosaleen Ow, PhD, is senior lecturer, Department of Social Work, National University of Singapore
| | - Rosaleen Ow
- Kareen N. Tonsing, PhD, is assistant professor of social work, Department of Sociology, Anthropology, Social Work and Criminal Justice, Oakland University, 531 Varner Hall, 371 Varner Drive, Rochester, MI 48309; e-mail: . Rosaleen Ow, PhD, is senior lecturer, Department of Social Work, National University of Singapore
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Bruggers CS, Baranowski S, Beseris M, Leonard R, Long D, Schulte E, Shorter A, Stigner R, Mason CC, Bedrov A, Pascual I, Bulaj G. A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases. Front Pediatr 2018; 6:69. [PMID: 29686977 PMCID: PMC5900044 DOI: 10.3389/fped.2018.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. METHODS Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. RESULTS A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! CONCLUSION Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.
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Affiliation(s)
- Carol S Bruggers
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Primary Children's Hospital, Salt Lake City, UT, United States
| | | | | | | | - Derek Long
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | | | | | - Rowan Stigner
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | - Clinton C Mason
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Alisa Bedrov
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Ian Pascual
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Juan Diego Catholic High School, Draper, UT, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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Bosworth A, Goodman EL, Wu E, Francisco L, Robison LL, Bhatia S. The Minneapolis-Manchester Quality of Life Instrument: reliability and validity of the Adult Form in cancer survivors. Qual Life Res 2017; 27:321-332. [PMID: 28770428 DOI: 10.1007/s11136-017-1671-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Childhood cancer survivors are at risk for deficits in health-related quality of life (HRQL) as they age. Youth (8-12 years) and adolescent (13-20 years) versions of the Minneapolis-Manchester Quality of Life Instrument (MMQL) have been developed to address survivor-specific issues and are currently in use; the MMQL-Adult Form has now been developed to assess HRQL in childhood cancer survivors aged 21-55 years. METHODS The MMQL-Adult Form was administered to 499 adults: 65 cancer patients on-therapy, 107 off-therapy, and 327 healthy controls. Forty-four percent of patients were under 30 years old at cancer diagnosis. Principal components analysis was performed. We evaluated internal consistency reliability, stability (re-administration of the MMQL-Adult Form 2 weeks later), construct validity (concurrent administration of the SF-36), and known-groups validity (score comparisons across the three groups). RESULTS Principal components analysis resulted in retention of 44 items across six scales: social functioning, physical functioning, cognitive functioning, outlook on life, body image, and psychological functioning. Internal consistency (Cronbach's α) was 0.80-0.90 for individual scales and 0.95 overall. Strong intraclass correlations (0.98 overall) indicated high stability. The MMQL-Adult Form distinguished between known groups; healthy controls scored better than patients on four of six scales. The MMQL-Adult Form scales correlated highly with similar SF-36 scales, demonstrating construct validity. CONCLUSIONS The MMQL-Adult Form is a reliable and valid self-report instrument for measuring multidimensional HRQL in cancer survivors. Development of this instrument ensures availability of a tool enabling cross-sectional and longitudinal assessment of HRQL in childhood cancer survivors as they age.
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Affiliation(s)
- Alysia Bosworth
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | | | - Eric Wu
- Department of Population Sciences, City of Hope, Duarte, CA, USA
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder 500, Birmingham, AL, 35233, USA.
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Schulte F, Russell KB, Cullen P, Embry L, Fay-McClymont T, Johnston D, Rosenberg AR, Sung L. Systematic review and meta-analysis of health-related quality of life in pediatric CNS tumor survivors. Pediatr Blood Cancer 2017; 64. [PMID: 28266804 DOI: 10.1002/pbc.26442] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pediatric central nervous system (CNS) tumor survivors are at high risk for numerous late effects including decreased health-related quality of life (HRQOL). Our objective was to summarize studies describing HRQOL in pediatric CNS tumor survivors and compare HRQOL outcomes in studies that included a comparison group. PROCEDURE EMBASE, MEDLINE, and PsychINFO were used to identify relevant articles published until August, 2016. Eligible studies reported outcomes for pediatric CNS tumor survivors diagnosed before age 21, at least 5 years from diagnosis and/or 2 years off therapy and used a standardized measure of HRQOL. All data were abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0. RESULTS Of 1,912 unique articles identified, 74 were included in this review. Papers described 29 different HRQOL tools. Meta-analyses compared pediatric CNS tumor survivors to healthy comparisons and other pediatric cancer survivors separately. HRQOL was significantly lower for CNS (n = 797) than healthy comparisons (n = 1,397) (mean difference = -0.54, 95% confidence interval [CI] = -0.72 to -0.35, P < 0.001, I2 = 35%). HRQOL was also significantly lower for CNS (n = 244) than non-CNS survivors (n = 414) (mean difference = -0.56, 95% CI = -0.73 to -0.38, P < 0.00001, I2 = 0%). CONCLUSIONS Pediatric CNS tumor survivors experience worse HRQOL than healthy comparisons and non-CNS cancer survivors. Future HRQOL work should be longitudinal, and/or multisite studies that examine HRQOL by diagnosis and treatment modalities.
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Affiliation(s)
- Fiona Schulte
- Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Haematology, Oncology and Transplant Program, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - K Brooke Russell
- Haematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Departments of Oncology and Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Cullen
- Loretto Heights School of Nursing, Regis University, Denver, Colorado
| | - Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Taryn Fay-McClymont
- Departments of Oncology and Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Johnston
- Department of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Abby R Rosenberg
- Department of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington
| | - Lillian Sung
- Department of Haematology/Oncology, SickKids Hospital, Toronto, Ontario, Canada
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Zhou ES, Vrooman LM, Manley PE, Crabtree VM, Recklitis CJ. Adapted Delivery of Cognitive-Behavioral Treatment for Insomnia in Adolescent and Young Adult Cancer Survivors: A Pilot Study. Behav Sleep Med 2017; 15:288-301. [PMID: 27077226 DOI: 10.1080/15402002.2015.1126597] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adolescent and young adult cancer survivors (AYACS) are at risk for the development of insomnia, though it remains vastly undertreated. Limited research has evaluated cognitive-behavioral treatment for insomnia (CBT-I) in AYACS. The present study piloted adapted CBT-I designed to improve treatment accessibility by delivering a three-session intervention in person and via videoconference. AYACS with insomnia (N = 12) enrolled in the study. Ten AYACS completed the intervention, with six in person and four via videoconference. Sleep variables improved immediately postintervention and were sustained at two-month follow-up. Within sample effect sizes of the adapted intervention for sleep, variables were large, and there were no noted differences on sleep outcomes between the in-person and videoconference participants. These pilot findings indicate that an adapted CBT-I intervention is feasible and promising in AYACS populations.
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Affiliation(s)
- Eric S Zhou
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts
| | - Lynda M Vrooman
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts.,c Department of Pediatrics, Boston Children's Hospital , Boston , Massachusetts
| | - Peter E Manley
- b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts.,c Department of Pediatrics, Boston Children's Hospital , Boston , Massachusetts.,d Pediatric Neuro-Oncology Clinic, Dana-Farber Cancer Institute , Boston , Massachusetts
| | - Valerie M Crabtree
- e Department of Psychology, St. Jude Children's Research Hospital , Memphis , Tennessee
| | - Christopher J Recklitis
- a David B. Perini Jr. Quality of Life Clinic , Dana-Farber Cancer Institute , Boston , Massachusetts.,b Department of Pediatrics, Harvard Medical School , Boston , Massachusetts
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40
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Penn A, Kuperberg A, Zebrack BJ. Psychosocial Issues in Adolescent and Young Adult Patients and Survivors. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Johannsdottir IM, Karlstad Ø, Loge JH, Fosså SD, Kiserud C, Skurtveit S. Prescriptions of Antidepressants to Survivors of Cancer in Childhood, Adolescence, and Young Adulthood: A Population-Based Study. J Adolesc Young Adult Oncol 2016; 6:120-126. [PMID: 27841952 DOI: 10.1089/jayao.2016.0041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Survivors of cancer may experience higher rates of psychological problems requiring pharmacological interventions than age-matched controls from the general population. This study compares prescription rates of antidepressants in survivors of cancer, diagnosed in childhood, adolescence, or early adulthood, to the rate in age- and gender-matched controls from the Norwegian population. METHODS Antidepressants prescribed to 5341 cancer survivors, diagnosed ≤25 years during 1965-2000, were studied in a population-based cohort by linking data from the following nationwide registries: the Population Registry of Norway, the Cancer Registry of Norway, and the Norwegian Prescription Database. For each survivor, three age- and gender-matched controls were randomly selected from the population. A Cox proportional hazard model was applied to estimate hazard ratios (HRs) of antidepressant prescriptions during 2004-2012 to the survivors with controls as referents. RESULTS Survivors had an increased risk of being prescribed antidepressants with crude rates of 26.9/1000 person-years compared with 22.5/1000 person-years in controls (HR 1.19; 95% confidence interval [CI] 1.12-1.28). The relative risk was highest for survivors of central nervous system tumors (HR 1.30; 95% CI 1.04-1.63), leukemias (HR 1.29; 95% CI 1.03-1.63), testicular tumors (HR 1.27; 95% CI 1.04-1.55), and "other tumors" (HR 1.42; 95% CI 1.10-1.84). No effect of age at cancer diagnosis was found. CONCLUSION Certain groups of survivors of cancer in childhood, adolescence, or young adulthood have a slightly increased risk for being prescribed antidepressants than their peers. The results may indicate an increased prevalence of depression among these survivors, but diagnostic reasons for prescriptions need to be confirmed in clinical studies.
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Affiliation(s)
- Inga Maria Johannsdottir
- 1 National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital , Oslo, Norway .,2 Department of Pediatric Hematology/Oncology, Oslo University Hospital , Oslo, Norway
| | - Øystein Karlstad
- 3 Department of Pharmacoepidemiology, Norwegian Institute of Public Health , Oslo, Norway
| | - Jon H Loge
- 4 Department of Behavioral Sciences in Medicine, University of Oslo , Oslo, Norway .,5 Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital , Oslo, Norway
| | - Sophie D Fosså
- 1 National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital , Oslo, Norway
| | - Cecilie Kiserud
- 1 National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital , Oslo, Norway
| | - Svetlana Skurtveit
- 6 Department of Mental Disorders, Norwegian Institute of Public Health , Oslo, Norway .,7 Norwegian Centre for Addiction Research, University of Oslo , Oslo, Norway
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42
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Stinson JN, Jibb LA, Greenberg M, Barrera M, Luca S, White ME, Gupta A. A Qualitative Study of the Impact of Cancer on Romantic Relationships, Sexual Relationships, and Fertility: Perspectives of Canadian Adolescents and Parents During and After Treatment. J Adolesc Young Adult Oncol 2016; 4:84-90. [PMID: 26812556 DOI: 10.1089/jayao.2014.0036] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We sought to gain insight into perspectives around core domains of adolescent development--romantic relationships, sexual relationships, and fertility--from the vantage point of Canadian adolescents and parents during and after cancer treatment. METHODS Twenty adolescents (12-17 years old at interview) and 20 parents (who may or may not have had an adolescent interviewed) participated in this study. Using a semistructured guide, adolescents and parents were interviewed separately. All interviews were audio-recorded and transcribed. Transcribed interview data were independently coded according to the study objectives by two trained analysts. Codes were organized into categories that reflected emerging themes. Discrepancies in coding were resolved through discussion with the lead investigator. RESULTS Qualitative analysis revealed main themes for adolescents and parents related to: (1) romantic relationships (opinions on the importance of dating in the context of cancer, expectations that cancer will impact future relationships, dating as a source of moral support, and limited opportunities to engage with partners); (2) sexual relationships (thoughts related to the impact of cancer on future sexual relationships); (3) fertility (initiating treatment as a primary concern and fear of infertility and perceived consequences); and (4) recommendations for care (access to knowledge and support through adolescent-friendly and accessible means). CONCLUSION Findings from this study highlight cancer-specific relationship and fertility issues faced by adolescents and provide important direction to the development of interventions that may ultimately improve the psychosocial health of adolescents during and after cancer treatment.
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Affiliation(s)
- Jennifer N Stinson
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada .,2 Department of Anesthesia and Pain Medicine, Hospital for Sick Children , Toronto, Ontario, Canada .,3 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada
| | - Lindsay A Jibb
- 3 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto , Toronto, Ontario, Canada .,4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,5 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada
| | - Mark Greenberg
- 4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,5 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Maru Barrera
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada .,4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada
| | - Stephanie Luca
- 1 Department of Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Ontario, Canada
| | | | - Abha Gupta
- 4 Division of Hematology/Oncology, Hospital for Sick Children , Toronto, Ontario, Canada .,6 Faculty of Medicine, University of Toronto , Toronto, Ontario, Canada .,8 Adolescent and Young Adult Program, Princess Margaret Cancer Centre , Toronto, Ontario, Canada
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43
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Macpherson CF, Hooke MC, Friedman DL, Campbell K, Withycombe J, Schwartz CL, Kelly K, Meza J. Exercise and Fatigue in Adolescent and Young Adult Survivors of Hodgkin Lymphoma: A Report from the Children's Oncology Group. J Adolesc Young Adult Oncol 2016; 4:137-40. [PMID: 26421221 DOI: 10.1089/jayao.2015.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fatigue is a significant problem for adolescent and young adult (AYA) Hodgkin lymphoma (HL) survivors. The relationship between exercise and fatigue is complex. This study explored the trajectory of and the relationship between exercise and fatigue over 36 months post-therapy in a cohort of 103 AYA-aged HL survivors treated on Children's Oncology Group (COG) study AHOD0031. Descriptive statistics and generalized estimating equations were used in this secondary data analysis. Exercise and fatigue improved over time but were unrelated; amount of exercise at end of therapy predicted amount of exercise at 12 (p = 0.02) and 36 (p = 0.0008) months post-therapy.
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Affiliation(s)
- Catherine Fiona Macpherson
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles, California
| | - Mary C Hooke
- School of Nursing, University of Minnesota School of Nursing , Minneapolis, Minnesota
| | - Debra L Friedman
- Vanderbilt University and Vanderbilt-Ingram Cancer Center , Nashville, Tennessee
| | - Kristin Campbell
- Vanderbilt University Medical Center and School of Nursing ; Nashville, Tennessee
| | - Janice Withycombe
- Department of Pediatric Oncology, Palmetto Health Children's Hospital , Columbia, South Carolina
| | - Cindy L Schwartz
- Brown University and Hasbro Children's Hospital ; Providence, Rhode Island
| | - Kara Kelly
- New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center , New York
| | - Jane Meza
- Department of Biostatistics, University of Nebraska Medical Center Department of Biostatistics , Omaha, Nebraska
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Frederick NN, Recklitis CJ, Blackmon JE, Bober S. Sexual Dysfunction in Young Adult Survivors of Childhood Cancer. Pediatr Blood Cancer 2016; 63:1622-8. [PMID: 27163396 DOI: 10.1002/pbc.26041] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/07/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Disruption of psychosexual development and sexual dysfunction are well recognized as profoundly distressing long-term side effects of pediatric cancer treatment. However, little is known about the specific sexual problems facing young adult survivors of childhood cancer (YASCC) and their unmet clinical needs. In this study, we aimed to utilize qualitative methods to characterize sexual dysfunction in YASCC and identify survivor-reported unmet clinical need regarding sexual health information and care. PROCEDURE Semistructured interviews were conducted with 22 YASCC (ages 18-31; 10 men, 12 women) reporting sexual dysfunction. Interviews were conducted in English by phone or in person. All interviews were audiorecorded, transcribed verbatim, and analyzed using a thematic analysis approach. Inductive open-coding procedures identified participants' experiences with sexual dysfunction and clinical care needs. Themes were identified by grouping pattern-forming codes in the data. RESULTS Interviews with YASCC reporting sexual dysfunction revealed five overarching themes including interruption of adolescent psychosocial development, physical and psychological problems with sexual function, altered perceptions of body image, concern about fertility, and inadequate clinical support. CONCLUSIONS The experiences described by YASCC provide valuable insight into the nature of sexual dysfunction in this population and their clinical care needs. These data provide the framework for future research on sexual dysfunction screening measures, patient-physician communication, and effective interventions to address sexual dysfunction in YASCC.
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Affiliation(s)
- Natasha N Frederick
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA.,Perini Family Survivors' Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Christopher J Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jaime E Blackmon
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sharon Bober
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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46
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Tougas AM, Jutras S, Bigras M. Types and Influence of Social Support on School Engagement of Young Survivors of Leukemia. J Sch Nurs 2016; 32:281-93. [DOI: 10.1177/1059840516635711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present study aimed to describe and explore the influence of social support on the school engagement of young survivors of pediatric leukemia. Fifty-three young Quebecers, previously diagnosed and treated for leukemia, completed a questionnaire measuring their school engagement and participated in an interview focusing on the support offered by four groups of relations with regard to school: parents, siblings, friends, and other nonprofessional relations. The interview responses revealed that parents were perceived to be the primary source of informational and emotional support, with support also provided to a lesser extent by friends, siblings, and members of the extended family. Inferential analyses indicated that young survivors report a higher school engagement score when they perceive themselves as receiving support from a greater number of groups of relations, especially from friends or siblings.
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Affiliation(s)
| | - Sylvie Jutras
- Université du Québec à Montréal, Montréal, QC, Canada
| | - Marc Bigras
- Université du Québec à Montréal, Montréal, QC, Canada
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Abstract
Adolescents and young adults with cancer (AYA) have strikingly poorer outcomes when compared to younger or older patients. Contributing reasons include low rates of enrollment in clinical trials and the “invisibility” of the AYA perspectives in research reports. We recommend a shift in research perspectives away from function-based studies that focus on morbidity and mortality outcomes to meaning-based models that will very likely rely upon qualitative methods and findings as the basis for developing psychosocial interventions that are sensitive to the AYA cancer experience. In addition, research on positive health concepts such as hope, spirituality, and positive coping are recommended as a way to learn about the effective strategies used by AYA to adjust to the cancer experience.
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Affiliation(s)
- Joan E Haase
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
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48
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Müller C, Krauth KA, Gerß J, Rosenbaum D. Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program. SUPPORTIVE CARE IN CANCER : OFFICIAL JOURNAL OF THE MULTINATIONAL ASSOCIATION OF SUPPORTIVE CARE IN CANCER 2016. [PMID: 27056572 DOI: 10.1007/s00520-016-3198-y.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing. METHODS A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL(®) questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models. RESULTS Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p < 0.05). While leukemia and lymphoma patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p < 0.001) and sustainable effects on HRQoL global scores (6-month follow-up, t = 4.08, p < 0.001; 12-month follow-up, t = 3.13, p < 0.006). CONCLUSIONS Immediate and sustainable increases in HRQoL indicate that a 4-week rehabilitation program is beneficial for improving psychosocial well-being, while the significant increase in PA levels could be related to general recovery as well. The lack of a control group hampers the evaluation of the rehabilitation program on promoting PA levels in pediatric cancer patients.
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Affiliation(s)
- Carsten Müller
- Institute of Sports Science, Work Unit Human Performance and Training in Sports, University of Münster, Horstmarer Landweg 62b, 48149, Münster, Germany. .,Institute of Experimental Musculoskeletal Medicine, Movement Analysis Laboratory, University Hospital Münster, Domagkstr. 3, 48149, Münster, Germany.
| | | | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstr. 56, 48149, Münster, Germany
| | - Dieter Rosenbaum
- Institute of Experimental Musculoskeletal Medicine, Movement Analysis Laboratory, University Hospital Münster, Domagkstr. 3, 48149, Münster, Germany
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49
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Müller C, Krauth KA, Gerß J, Rosenbaum D. Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program. Support Care Cancer 2016; 24:3793-802. [PMID: 27056572 DOI: 10.1007/s00520-016-3198-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/28/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing. METHODS A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL(®) questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models. RESULTS Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p < 0.05). While leukemia and lymphoma patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p < 0.001) and sustainable effects on HRQoL global scores (6-month follow-up, t = 4.08, p < 0.001; 12-month follow-up, t = 3.13, p < 0.006). CONCLUSIONS Immediate and sustainable increases in HRQoL indicate that a 4-week rehabilitation program is beneficial for improving psychosocial well-being, while the significant increase in PA levels could be related to general recovery as well. The lack of a control group hampers the evaluation of the rehabilitation program on promoting PA levels in pediatric cancer patients.
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Affiliation(s)
- Carsten Müller
- Institute of Sports Science, Work Unit Human Performance and Training in Sports, University of Münster, Horstmarer Landweg 62b, 48149, Münster, Germany. .,Institute of Experimental Musculoskeletal Medicine, Movement Analysis Laboratory, University Hospital Münster, Domagkstr. 3, 48149, Münster, Germany.
| | | | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstr. 56, 48149, Münster, Germany
| | - Dieter Rosenbaum
- Institute of Experimental Musculoskeletal Medicine, Movement Analysis Laboratory, University Hospital Münster, Domagkstr. 3, 48149, Münster, Germany
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50
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Bitsko MJ, Cohen D, Dillon R, Harvey J, Krull K, Klosky JL. Psychosocial Late Effects in Pediatric Cancer Survivors: A Report From the Children's Oncology Group. Pediatr Blood Cancer 2016; 63:337-43. [PMID: 26488337 PMCID: PMC4715481 DOI: 10.1002/pbc.25773] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/31/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND This review was conducted to update the Children's Oncology Group (COG) Long-Term Follow-Up Guidelines (COG-LTFU Guidelines, version 4.0) regarding screening for psychosocial late effects of pediatric cancer. PROCEDURE Articles published between August 2009 and January 2011 that addressed psychosocial late effects of long-term survivors of pediatric cancer (n = 35) were reviewed by a multidisciplinary team of COG late effect experts. RESULTS The majority of studies in this time period indicate that survivors experience few psychosocial problems in long-term survivorship. A critical subset, however, is at increased risk for psychosocial late effects secondary to the treatment. Highlighted findings from this review include increased rates of suicidal ideation (SI), and health beliefs as robust predictors of SI, anxiety, and global distress. Survivors' health beliefs were associated with their perceptions of physical limitations, overall late effects, and cancer-related pain. While many survivorship studies continue to specify risk factors for anxiety and posttraumatic stress symptoms/posttraumatic stress disorder, others outcomes (e.g., developmental, interpersonal, and familial factors) appear to be emerging in importance. CONCLUSIONS Although the majority of childhood cancer survivors do not experience psychosocial problems, a subset will. The recent research findings have been included in the new COG-LTFU Guidelines that will assist in the targeted assessment and the treatment of survivors' psychosocial health.
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Affiliation(s)
- Matthew J. Bitsko
- Children’s Hospital of Richmond, Richmond, VA 23298, USA,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA,Correspondence to: Matthew J. Bitsko, PhD, Children’s Hospital of Richmond at VCU, Department of Pediatrics, PO Box 980440, Virginia Commonwealth University, Richmond, VA 23298-0440, Tel: 804-828-9048,
| | - Debra Cohen
- Children’s Hospital of Richmond, Richmond, VA 23298, USA,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Robyn Dillon
- Children’s Hospital of Richmond, Richmond, VA 23298, USA,Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Jeanne Harvey
- Cardinal Glennon Children’s Medical Center, St. Louis, MO, USA
| | - Kevin Krull
- Departments of Epidemiology & Cancer Control and Psychology
| | - James L. Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis TN, USA
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