Psychosocial developmental milestones of young adult survivors of childhood cancer

Burden of Childhood Cancer and the Social and Economic Challenges in Adulthood: A Systematic Review and Meta-Analysis

Importance

Significant advancements in pediatric oncology have led to a continuously growing population of survivors. Although extensive research is being conducted on the short-, medium-, and long-term somatic effects, reports on psychosocial reintegration are often conflicting; therefore, there is an urgent need to synthesize the evidence to obtain the clearest understanding and the most comprehensive answer.

Objective

To provide a comprehensive review and analysis of the socioeconomic attainment of childhood cancer survivors (CCSs) compared with their unaffected peers.

Data Sources

A systematic review and meta-analysis was conducted using data obtained from a comprehensive search of MEDLINE (via PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases on October 23, 2021; the search was updated until July 31, 2023.

Study Selection

Eligible articles reported on educational attainment, employment, family formation, quality of life (QoL), or health-risk behavior-related outcomes of CCSs, and compared them with their unaffected peers. Study selection was performed in duplicate by 4 blinded independent coauthors.

Data Extraction and Synthesis

Data extraction was performed in duplicate by 4 independent authors following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures were odds ratios (ORs) and mean differences with 95% CIs; data were pooled using a random-effects model.

Results

The search identified 43 913 articles, 280 of which were eligible for analysis, reporting data on a total of 389 502 survivors. CCSs were less likely to complete higher levels of education (OR, 0.69; 95% CI, 0.40-1.18), had higher odds of health-related unemployment (OR, 2.94; 95% CI, 1.90-4.57), and showed lower rates of marriage (OR, 0.72; 95% CI, 0.63-0.84) and parenthood (OR, 0.60; 95% CI, 0.49-0.74) compared with population-based controls.

Conclusion and Relevance

Study findings suggest that CCSs face several socioeconomic difficulties; as a result, the next goal of pediatric oncology should be to minimize adverse effects, as well as to provide lifelong survivorship support aimed at maximizing social reintegration.

Unveiling perspectives on the psychosocial impacts of childhood cancer survival on young adult survivors' reassimilation journey: A qualitative exploration

Background

Approximately 82% of children with childhood cancer survive more than five years after diagnosis. Living as a cancer survivor elicits a new reality that can include psychosocial impacts. These psychosocial impacts interact collectively, especially regarding reassimilation, and are rarely explored.

Objective

To explore the psychosocial impacts of surviving childhood cancer and reassimilation back into society in young adult survivors of childhood cancer.

Methodology

Individual in-depth semi-structured interviews were conducted with childhood cancer survivors and explored psychosocial aspects associated with returning to work, school, and social environments after remission. Interpretive phenomenological analysis was conducted once interviews were manually transcribed. A group interview with survivors was held to discuss the study's findings and interpretation.

Results

Individual interviews and the group interview revealed three major themes: outlook on reassimilating, outlook on coping, and outlook on cancer.

Conclusions

This work is a first step to understanding how survivors' personal outlook on coping and healthcare system barriers play influential roles in reassimilation following cancer treatment. Survivors expressed the need for reliable survivorship information and improved communication with healthcare providers regarding what to expect, so they could feel prepared for life post-cancer. These aspects need to be explored more deeply through other qualitative studies.

Regards sur les séquelles psychosociales des cancers pédiatriques sur le parcours de réintégration des jeunes survivants devenus adultes: étude qualitative exploratoire

Contexte

Environ 82 % des personnes atteintes d’un cancer pendant l’enfance survivent plus de 5 ans après le diagnostic. La survivance transforme leur quotidien et entraîne parfois des difficultés psychosociales. Les séquelles psychosociales – rarement étudiées – sont interreliées, surtout en ce qui concerne la réinsertion aux activités normales.

Objectif

Examiner les effets psychosociaux de la survie au cancer pédiatrique et la réinsertion sociale des jeunes adultes.

Méthodologie

Des entrevues individuelles semi-structurées détaillées ont été réalisées auprès de personnes ayant survécu à un cancer pédiatrique afin d’étudier les aspects psychologiques du retour au travail, à l’école et en société après la rémission. Après la transcription manuelle des entrevues, on a procédé à une analyse phénoménologique interprétative. Un groupe de discussion a été organisé pour permettre aux survivants de discuter des résultats de l’étude et de l’interprétation des données.

Résultats

Les entrevues individuelles et le groupe de discussion ont fait ressortir trois grands thèmes: le regard porté sur la réinsertion, le regard porté sur l’adaptation et le regard porté sur le cancer.

Conclusions

La présente recherche amorce une démarche visant à comprendre en quoi le regard que portent les survivants sur l’adaptation et les obstacles liés au système de santé influence la réintégration après le cancer. Les survivants ont exprimé le besoin d’obtenir des renseignements fiables sur la survivance au cancer et d’être mieux informés par leurs professionnels de la santé afin de se préparer à la vie après le cancer. Ces aspects devront faire l’objet d’autres études qualitatives détaillées.

The Effect of Family Characteristics on the Functioning of a Child with an Autistic Spectrum Disorder in Bedouin Society in Israel

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by difficulties in communication and social-emotional interaction. It is associated with an increase of parental stress and poor family functioning, both of which are harmful for a child's functioning and adaptive behavior. An important source of support to parents are grandparents, especially in traditional populations. One such population is the Bedouin population. The present study tested the association between emotional support from mother and mother-in-law to the adaptive behavior of children with ASD, and whether this relation is serially mediated by family functioning and satisfaction in life as reported by Bedouin mothers of children with ASD. 100 mothers of children with ASD fulfilled a questionnaire about emotional support from their mothers and mother-in-law, family functioning, satisfaction in life and child's adaptive behavior. We found that indeed, family functioning and satisfaction in life serially mediated the relations between emotional support from mother and mother-in-law and child adaptive behavior. These findings indicate that intergenerational solidarity between women can improve not only the functioning of the nuclear family and wife's satisfaction with life, but also, indirectly, the adaptive behavior of a child with ASD. It highlights the importance of women solidarity, especially in traditional society, where women are kept marginal.

Identifying social outcomes of importance for childhood cancer survivors: an e-Delphi study

PURPOSE

Childhood cancer survivors (CCS) are at risk of deficits in their social outcomes, a key aspect of overall health and quality of life. Social outcomes of import are ill-defined leading to potential gaps in research and service provision. In this study, we undertook a preliminary consensus seeking exercise to support the development of a framework of the important social outcomes for CCS.

METHODS

A modified e-Delphi study was conducted with four groups: CCS, health professionals, social workers and teachers. Round 1, developed from a literature review, included 34 questions rated for importance on a 7-point Likert scale. Rounds 2 and 3 presented items not achieving consensus, additionally proposed items and in round 3, a ranking question.

RESULTS

Survey 1 was completed by 38 participants, 31 (82%) completed survey 2 and 28 (76%) completed survey 3. A total of 36 items were prioritised across 6 domains (education, independence, work, relationships, community, lifestyle), together forming the final list of social outcomes. Of these, 22 items met consensus for importance. Items rated most important were "having autonomy" and "avoiding social isolation". Quantitative and qualitative results reflected that social outcomes for survivors and general public should be the same.

CONCLUSION

We have generated initial consensus on important social outcomes for CCS, highlighting the need for these to be matched to those of the general population. It suggests strategies are required to ensure autonomy and appropriate support for independence and relationships are provided through long-term aftercare and beyond. Further work is needed to validate and develop these findings into a framework to support appropriate social aftercare for CCS.

Measurement Properties of Patient-Reported Outcome Measures for Adolescent and Young Adult Survivors of a Central Nervous System Tumor: A Systematic Review

Purpose: To identify and evaluate patient-reported outcome measures (PROMs) for assessing survivorship-related concepts for adolescent and young adult (AYA) survivors of central nervous system (CNS) tumors. Methods: We searched five electronic databases. Two researchers independently screened all titles for inclusion and used consensus-based standards for the selection of health measurement instruments (COSMIN) guidance to grade the quality of evidence for each measurement property. Results: Four studies met eligibility criteria: single-item pain thermometer; single-item fatigue thermometer; 37-item pediatric functional assessment of cancer therapy-brain tumor survivors, measuring quality of life; and 12-item Perceived Barriers Scale to assess barriers to employment. The Perceived Barrier Scale showed high-quality evidence for internal consistency and moderate quality evidence for construct and structural validity. Evidence for the measurement properties of the other PROMs was low-to-moderate quality. Conclusion: We found one PROM with sufficient evidence for good measurement properties to support its use. This warrants development and evaluation of further PROMs to inform ongoing supportive care for this population. Implications for Cancer Survivors: The Perceived Barriers Scale is sufficiently validated and could be considered to guide support for AYA survivors of CNS tumors to achieve their employment goals.