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Wilharm C, Pralong A, Weiß M, Blütgen S, Hallek M, Voltz R, Simon ST, Tuchscherer A. "The Most Important Thing is That You Are Not Left Alone"-A Qualitative Study of Challenges and Needs of Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2024. [PMID: 38770689 DOI: 10.1089/jayao.2023.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Purpose: We aimed to gain in-depth insights into the challenges and needs of adolescents and young adults with cancer (AYA) throughout their disease to detect increased needs for support. Methods: We conducted face-to-face interviews with 15 patients 18-39 years old at the time of diagnosis of malignancies who had completed treatment at the time of the interview. The interviews were analyzed using content analysis. Results: The unexpected diagnosis of a serious illness shocked the participants, especially since many were in a life phase of transition at that time and had little knowledge about cancer and its therapy. They reported feelings of helplessness, unfairness, and insecurity triggered by side effects, divergent information from health care professionals (HCPs), or lack of information. After the end of the therapy, many AYAs were challenged by prolonged changes in their lives since they gained strength from the hope of returning to "the life before." The primary needs were social and psychological support, connecting with peers, orientation, and guidance. Conclusion: AYAs face special challenges requiring support and guidance from HCPs that should extend beyond the end of the therapy. There is a need for exchange opportunities with other AYAs. Trial Registration Number: DRKS00030277 (German Clinical Trials Register); September 27, 2022.
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Affiliation(s)
- Carolin Wilharm
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
| | - Anne Pralong
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
| | - Mara Weiß
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
| | - Saskia Blütgen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), Koln, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), Koln, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Center for Health Services Research (ZVFK), Koln, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), Koln, Germany
| | - Armin Tuchscherer
- Department I of Internal Medicine, Faculty of Medicine and University Hospital, University of Cologne, Koln, Germany
- Faculty of Medicine and University Hospital, University of Cologne, Center for Integrated Oncology Cologne Aachen Bonn Cologne Duesseldorf (ABCD), Koln, Germany
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Knoerl R, Grandinetti K, Smener L, Doll E, Fecher LA, Henry NL, Karimi Y, Pettit K, Schuetze S, Walling E, Zhang A, Barton D. Exploring Adolescent and Young Adult Cancer Survivors' Experience with Cancer Treatment-Related Symptoms: A Qualitative Analysis of Semi-Structured Interviews. J Adolesc Young Adult Oncol 2024. [PMID: 38634665 DOI: 10.1089/jayao.2024.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Purpose: Few studies have specifically targeted symptom management interventions for adolescent and young adult (AYA) cancer survivors. A greater understanding of AYA cancer survivors' experiences with cancer treatment-related symptoms would help develop age-appropriate oncology symptom management interventions. The purpose of this qualitative analysis was to explore AYA cancer survivors' experience with cancer treatment-related symptoms. Methods: Nineteen post-treatment AYA cancer survivors (18-39 years old) who self-reported moderate-severe cancer treatment-related symptom severity participated in video conferencing or telephone interviews. The questions in the interview guide queried participants to share their experience with cancer treatment-related symptoms. Inductive content analysis was used to identify themes from the interviews. Results: The themes that emerged from the interviews included (1) cancer treatment-related symptoms negatively affected AYA cancer survivors' quality of life (e.g., symptoms served as a reminder of cancer recurrence possibility); (2) AYA cancer survivors' attitudes and feelings about communicating cancer treatment-related symptom concerns to clinicians (e.g., patient-clinician communication was bolstered when AYAs perceived that symptoms were being taken seriously); (3) AYA cancer survivors are interested in oncology symptom management clinical trials, but logistical challenges are barriers to participation; and (4) AYA cancer survivors are interested in nonpharmacological treatments for symptom management. Conclusion: Results highlight the burden of cancer treatment-related symptoms on day-to-day life among post-treatment AYA cancer survivors. Future work is needed to identify nonpharmacological symptom management interventions, strategies to improve patient-clinician communication about symptoms, and strategies to increase the visibility and accessibility of symptom management clinical trials for AYA cancer survivors.
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Affiliation(s)
- Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | | | - Liat Smener
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Doll
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Leslie A Fecher
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - N Lynn Henry
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Yasmin Karimi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kristen Pettit
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott Schuetze
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Debra Barton
- College of Nursing, The University of Tennessee, Knoxville, Tennessee, USA
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Fernando RA. Improving Supportive and Palliative Care Integration in Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2024; 13:271-280. [PMID: 37878271 DOI: 10.1089/jayao.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Purpose: Timely supportive and palliative care (SPC) integration in adolescent and young adult (AYA) cancer management is recommended in curative and palliative settings. However, multiple barriers exist to implementing this goal. Liverpool Cancer Therapy Center (LCTC) serviced a growing AYA (15-39 years) population without AYA-dedicated services and the vast majority receiving no SPC engagement. Concerned this was placing AYA patients' wellbeing at risk, we determined a cultural change was required and that the newly established AYA Supportive and Palliative Care (AYASPC) Service could facilitate this. Methods: The AYASPC Service conducted a 6-month quality improvement project aiming to increase its referrals from a baseline average of one per month to four per month, to increase confidence in making SPC referrals and to enhance appreciation for specialized AYA care. Interventions included formalizing an AYASPC referral pathway with broad indications, and educating clinicians on holistic AYA care, the AYASPC Service's model of care (MoC) and AYASPC referral benefits. Results: During the project, 27 AYASPC referrals were made. Referrals consistently exceeded the Service's baseline, and from 3 months onward exceeded the project target. Additionally, referrals were made earlier (29.6% at diagnosis), for a variety of cancer diagnoses with varied prognoses, and for indications beyond traditional issues of complex symptoms and end-of-life care. Clinicians also expressed greater confidence in supporting AYAs and making SPC referrals. Conclusion: In a brief timeframe, the AYASPC Service's innovative and adaptable MoC and project interventions sustainably improved AYASPC access and affected a positive cultural shift around AYA care and advocacy.
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Ayvat İ, Atli Ozbas A. Is There a Difference in Unmet Supportive Care Needs Between Older and Younger Outpatients Receiving Chemotherapy? J Palliat Care 2024; 39:115-121. [PMID: 34665068 DOI: 10.1177/08258597211044248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study investigated whether there was a difference in unmet supportive care needs between older and younger cancer patients who receive chemotherapy. Background: Physiological, physical, cognitive, and social functions, which play a key role in coping with cancer, are impaired due to aging. Age-related physiological changes and psychosocial factors and comorbid medical conditions make some of the needs of older cancer patients unique and complex. At the heart of meeting these needs lies the concept of supportive care. First step of meeting their needs is to determine these needs. Study Design and Methods: The study was conducted in the Daytime Treatment Unit of the oncology hospital of a university in Ankara, Turkey. The study sample consisted of 93 patients aged 65 years or older and 93 patients under 65 years of age. Both groups were similar in terms of sex, cancer type, and chemotherapy protocols. Data were collected using a Patient Information Form and Supportive Care Needs Scale-Short Turkish Version and analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and Bonferroni correction. Results: Participants had a median total score of 1.92. Their "daily life needs" and "sexuality needs" subscale scores were highest and lowest, respectively. Older patients had lower median total scores than younger patients. Younger patients had higher median "health care and information needs" and "sexuality needs" subscale scores than older patients. Conclusion: Elderly patients reported fewer unmet needs than younger patients. This may be due to age-related cultural factors as they may have difficulty expressing their needs. Implications: Results suggest to focus on the fact that patients' needs change with age and that they have difficulty expressing their needs.
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Affiliation(s)
- İrem Ayvat
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Turkey
| | - Azize Atli Ozbas
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Turkey
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Malik M, Valiyaveettil D, Joseph DM. The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action. J Adolesc Young Adult Oncol 2024; 13:1-7. [PMID: 37327043 DOI: 10.1089/jayao.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa M Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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Rosenthal A, Duvall A, Kahn J, Khan N. Disparities in care and outcomes for adolescent and young adult lymphoma patients. EJHAEM 2023; 4:934-939. [PMID: 38024615 PMCID: PMC10660400 DOI: 10.1002/jha2.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023]
Abstract
Though survival outcomes among adolescents and young adults (AYAs) with lymphoma have improved over the last three decades, socially vulnerable populations including non-White, low-income, and publicly insured groups continue to trail behind on survival curves. These disparities, while likely the result of both biological and non-biological factors, can be largely attributed to inequities in care over the full cancer continuum. Nationally representative studies have demonstrated that from diagnosis through therapy and into long-term survivorship, socially vulnerable AYAs with lymphoma face barriers to care that impact their short and long-term survival. Thus, improving outcomes for all AYAs with lymphoma requires dedicated study to understand, and then address the unique challenges faced by non-White and low-income lymphoma populations within this age group.
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Affiliation(s)
- Allison Rosenthal
- Mayo Clinic Arizona Division of Hematology Medical OncologyPhoenixArizonaUSA
| | - Adam Duvall
- Department of MedicineSection of Hematology/OncologyUniversity of ChicagoChicagoIllinoisUSA
| | - Justine Kahn
- Department of PediatricsDivision of Pediatric Hematology/Oncology/Stem Cell TransplantationColumbia University Medical CenterNew YorkNew YorkUSA
| | - Niloufer Khan
- Department of Hematology and Hematopoietic Cell Transplantation DuarteCity of HopeDuarteCanada
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Francis-Levin N, Ghazal LV, Francis-Levin J, Zebrack B, Chen M, Zhang A. Exploring the Relationship between Self-Rated Health and Unmet Cancer Needs among Sexual and Gender Minority Adolescents and Young Adults with Cancer. Curr Oncol 2023; 30:9291-9303. [PMID: 37887571 PMCID: PMC10605547 DOI: 10.3390/curroncol30100671] [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] [Received: 08/30/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
This study evaluates the unmet needs of sexual and gender minority (SGM) adolescent and young adult (AYA) cancer survivors by comparing SGM AYA self-rated health (SRH) scores to their non-SGM (i.e., cisgender/heterosexual) counterparts. The Cancer Needs Questionnaire-Young People (CNQ-YP) and self-rated health measures were used to assess unmet needs in AYAs aged 15-39 who had been diagnosed with cancer in the previous ten years (n = 342). Participants were recruited from a National Cancer Institute (NCI) Comprehensive Cancer Center registry using the modified Dillman's method. Self-reported sexual orientation and gender identity (SO/GI) data were collected. Independent t-tests were used to test between-group differences in unmet needs and Pearson's chi-square test was used to determine the difference in SRH scores between SGM and non-SGM AYA cancer survivors. SGM AYA cancer survivors reported greater mean needs than their non-SGM counterparts across all six domains and reported significantly greater needs in the domains of Feelings and Relationships, t(314) = -2.111, p = 0.036, Information and Activities, t(314) = -2.594, p = 0.009, and Education, t(207) = -3.289, p < 0.001. SGM versus non-SGM SRH scores were significantly different, indicating that a higher percentage of SGM AYAs reported poor/fair health compared to those who were non-SGM. Unmet life and activities needs were negatively associated with AYA cancer survivors' SRH, whereas unmet work needs were positively associated with AYA cancer survivors' SRH. An AYA's gender identity (SGM versus non-SGM) was not a moderator. SGM AYAs are an understudied group within an already vulnerable patient population. Unmet psychosocial needs related to one's feelings and relationships, and information and activity needs merit further research to develop tailored interventions that reflect the experiences of SGM AYAs.
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Affiliation(s)
- Nina Francis-Levin
- Division of Endocrinology, Metabolism & Diabetes, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Lauren V. Ghazal
- School of Nursing, University of Rochester, Rochester, NY 14642, USA;
| | - Jess Francis-Levin
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA;
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA; (B.Z.); (M.C.)
| | - Meiyan Chen
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA; (B.Z.); (M.C.)
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA; (B.Z.); (M.C.)
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Adamakidou T, Menti K, Charalambous A, Tsiou C, Vlachou E, Govina O. Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study. Eur J Oncol Nurs 2023; 66:102358. [PMID: 37572628 DOI: 10.1016/j.ejon.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1). METHODS This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients. RESULTS A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004). CONCLUSION The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.
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Affiliation(s)
- Theodoula Adamakidou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Konstantina Menti
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece; Agios Savvas Anticancer Hospital, Athens, Greece.
| | | | - Chrysoula Tsiou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Eugenia Vlachou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Ourania Govina
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
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Phillips CS, Bockhoff J, Berry DL, Buchbinder E, Frazier AL, LaCasce A, Ligibel J, Luskin MR, Woods H, Knoerl R. Exploring Young Adults' Perspectives of Participation in a Mindfulness-Based Music Therapy Intervention Before and During the COVID-19 Pandemic. J Adolesc Young Adult Oncol 2023; 12:569-576. [PMID: 36752714 DOI: 10.1089/jayao.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Purpose: To explore adolescent and young adults' (AYAs) experiences with participation in a mindfulness-based music therapy intervention during cancer treatment before and during the COVID-19 pandemic. Methods: Sixteen young adults (20-39 years old) who received cancer treatment and participated in a mindfulness-based music therapy intervention for anxiety and stress were interviewed using a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. The interview guide contained prompts about reasons for joining the study, usual coping strategies, experience with the in-person and virtual delivery formats of the intervention, and suggestions for improvement. Themes were derived from the data using inductive content analysis methods. Results: Findings from the interviews included the following: (1) virtual group participants reported difficulty finding a private place to attend the intervention sessions, (2) participants experienced a sense of relaxation in response to intervention participation, (3) in-person group participants felt a sense of connection to the music and their family members who were present during the intervention, while virtual group participants felt a sense of connection to mindfulness, (4) virtual group participants reported that practicing music and mindfulness together was synergistic, and (5) in-person intervention delivery was preferred to virtual intervention delivery. Conclusion: This study provides insight into the contextual factors that impact satisfaction with the intervention and the effect of the intervention on anxiety and stress. Overall, while virtual mindfulness-based music therapy delivery may be more feasible, there are still important advantages to in-person delivery that should be considered in the design of future mindfulness-based music therapy interventions. ClinicalTrials.gov Identifier: NCT03709225.
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Affiliation(s)
- Carolyn S Phillips
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julianna Bockhoff
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Elizabeth Buchbinder
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather Woods
- The Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Hinz A, Lehmann-Laue A, Richter D, Hinz M, Schulte T, Görz E, Mehnert-Theuerkauf A. The Relationship between Supportive Care Needs and Health-Related Quality of Life in Cancer Patients. Healthcare (Basel) 2023; 11:2161. [PMID: 37570401 PMCID: PMC10418502 DOI: 10.3390/healthcare11152161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this study was to analyze the relationship between quality of life (QoL) and supportive care needs (SCNs) in cancer patients. It is difficult to relate SCNs to detriments in QoL since SCNs and QoL assessment tools generally comprise different dimensions that cannot be directly related to each other. Therefore, we developed a short questionnaire with eight dimensions for uniformly measuring SCNs, QoL, and the subjective importance of these dimensions. A total of 1108 cancer patients with mixed diagnoses assessed eight dimensions of health-related QoL concerning SCNs, satisfaction, and importance. Among the eight dimensions of QoL, physical functioning received the highest SCN assessments (M = 3.4), while autonomy (M = 20.7) and social relationships (M = 1.88) were the dimensions with the lowest SCN mean scores on the 1-5 scale. For each of the eight dimensions, high levels of SCNs were reported by those patients who had low levels of satisfaction with that dimension (r between -0.32 and -0.66). The subjective importance of the dimensions was not consistently correlated with SCNs (r between -0.19 and 0.20). Females reported higher SCNs than males in six of the eight specific dimensions. Patients with prostate and male genital cancers reported the lowest SCNs. These results suggest gender-specific SCN patterns that warrant further exploration. This study highlights the value of a unified assessment instrument for SCNs and QoL, providing a robust basis for future cancer care strategies.
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Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany (A.M.-T.)
| | - Antje Lehmann-Laue
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany (A.M.-T.)
| | - Diana Richter
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany (A.M.-T.)
| | - Michael Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany (A.M.-T.)
| | - Thomas Schulte
- Rehabilitation Clinic Bad Oexen, 32549 Bad Oeynhausen, Germany (E.G.)
| | - Evelyn Görz
- Rehabilitation Clinic Bad Oexen, 32549 Bad Oeynhausen, Germany (E.G.)
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany (A.M.-T.)
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Vrinzen CEJ, Bloemendal HJ, Jeurissen PPT. How to create value with constrained budgets in oncological care? A narrative review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:989-999. [PMID: 37650221 DOI: 10.1080/14737167.2023.2253375] [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: 06/15/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION As a result of an increasing focus on patient-centered care within oncology and more pressure on the sustainability of health-care systems, the discussion on what exactly constitutes value re-appears. Policymakers seek to improve patient values; however, funding all values is not sustainable. AREAS COVERED We collect available evidence from scientific literature and reflect on the concept of value, the possible incorporation of a wide spectrum of values in reimbursement decisions, and alternative strategies to increase value in oncological care. EXPERT OPINION We state that value holds many different aspects. For reimbursement decisions, we argue that it is simply not feasible to incorporate all patient values because of the need for efficient resource allocation. We argue that we should shift the value debate from the individual perspective of patients to creating value for the cancer population at large. The different strategies we address are as follows: (1) shared decision-making; (2) biomarkers and molecular diagnostics; (3) appropriate evaluation, payment and use of drugs; (4) supportive care; (5) cancer prevention and screening; (6) monitoring late effect; (7) concentration of care and oncological networking; and (8) management of comorbidities. Important preconditions to support these strategies are strategic planning, consistent cancer policies and data availability.
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Affiliation(s)
- Cilla E J Vrinzen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Haiko J Bloemendal
- Department of Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Jäkel K, Richter D, Leuteritz K, Sender A, Hinz A. Sexuality, fertility, family planning, family life, and partnership in young breast cancer patients: a longitudinal study. Front Psychol 2023; 14:1127359. [PMID: 37251020 PMCID: PMC10213958 DOI: 10.3389/fpsyg.2023.1127359] [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: 12/19/2022] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Adolescent and young adult (AYA) breast cancer patients are often faced with sexuality-related problems. Since healthcare providers are often unfamiliar with problems specific to AYA cancer this topic is too little integrated into routine oncological care. The objective of this study was to analyze sexuality, fertility, family planning, family life, and partnership regarding satisfaction and supportive care needs in AYA breast cancer patients. Methods A total of 139 AYA breast cancer patients were examined twice, 1 year apart. The patients were asked to complete several questionnaires and to answer multiple questions about satisfaction with sexuality, fertility, family planning, family life, and corresponding supportive care needs in these domains. Results While the patients were largely satisfied with their family life and partnerships, they were less satisfied with their sexuality and family planning. Only small mean score changes were observed in these variables over the course of a year. Being a parent already and having the possibility of further completing family planning were strongly associated with higher satisfaction and lower supportive care needs in these domains. Satisfaction was generally negatively associated with supportive care needs. Older age was predictive of lower satisfaction with sexuality at follow-up. Conclusion AYA cancer patients deserve special consultations concerning the impact of cancer and treatment on their sexuality and fertility, and it is especially important that women who have yet to complete their family planning be actively offered information and support concerning sexuality and fertility protection before beginning treatment.
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Braun I, Friedrich M, Morgenstern L, Sender A, Geue K, Mehnert-Theuerkauf A, Leuteritz K. Changes, challenges and support in work, education and finances of adolescent and young adult (AYA) cancer survivors: A qualitative study. Eur J Oncol Nurs 2023; 64:102329. [PMID: 37172338 DOI: 10.1016/j.ejon.2023.102329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/14/2023]
Abstract
PURPOSE An increasing number of adolescents and young adults (AYA) are becoming cancer survivors and are dealing with long-term effects of the disease and its treatment. We aimed to collect detailed self-reported information about the areas of work, education, and the financial situation of AYA survivors after acute treatment. We further examined sources of support that were perceived as particular helpful. METHOD We conducted semi-structured interviews with a sample of 11 AYA cancer survivors (on average 5 years from diagnosis; mean age at diagnosis = 25.7 years) that had been recruited for the AYA-Leipzig longitudinal study. Interviews were transcribed and data were analysed using qualitative content analysis. RESULTS The following themes emerged as relevant: (1) career modifications and job loss, (2) career interruptions and delays, (3) uncertainty in the return-to-work process, (4) reduced work ability, (5) discrimination at the workplace, (6) changes in the personal importance of work and (7) financial burdens. Sources of considerable support included relatives as well as German social security institutions. CONCLUSIONS Health care providers should address the specific risk of a financial burden and the somewhat complex social legal situation of young adult survivors after cancer diagnosis. AYA cancer survivors need age-specific comprehensive cancer survivorship support programs. These should accompany them in the long term and be targeted to the individual need for career modification or reorientation - even after the completion of cancer treatment and rehabilitation.
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Affiliation(s)
- Isabella Braun
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Michael Friedrich
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Larissa Morgenstern
- Sachsen-Anhaltische Krebsgesellschaft e.V, Schlossplatz 3, 06844, Dessau, Germany
| | - Annekathrin Sender
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Kristina Geue
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Katja Leuteritz
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
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14
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Knoerl R, Mazzola E, Woods H, Buchbinder E, Frazier L, LaCasce A, Luskin MR, Phillips CS, Thornton K, Berry DL, Ligibel J. Exploring Influencing Factors of Anxiety Improvement Following Mindfulness-Based Music Therapy in Young Adults with Cancer. J Music Ther 2023:7036622. [PMID: 36787235 DOI: 10.1093/jmt/thac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The purpose of this secondary analysis was to explore physiological, psychological, and situational influencing factors that may affect the impact of a mindfulness-music therapy intervention on anxiety severity in young adults receiving cancer treatment. Young adults receiving cancer treatment for ≥ eight weeks were recruited from adult and pediatric oncology outpatient centers at Dana-Farber Cancer Institute. Participants were asked to attend up to four, in-person (offered virtually via Zoom video conference after the onset of the COVID-19 pandemic) 45-min mindfulness-based music therapy sessions over twelve weeks with a board-certified music therapist. Participants completed questionnaires about anxiety, stress, and other cancer treatment-related outcomes before and after participating in the intervention. Changes in anxiety (i.e., PROMIS Anxiety 4a) over time were compared among baseline physiological (e.g., age or sex), psychological (e.g., stress), and situational influencing (i.e., intervention delivery format) factors using Wilcoxon-rank sum tests. Thirty-one of the 37 enrolled participants completed the baseline and post-intervention measures and were eligible for inclusion in the secondary analysis. Results revealed that higher baseline physical functioning (median change = -6.65), anxiety (median change=-5.65), fatigue (median change = -5.6), sleep disturbance (median change = -5.6), female sex (median change = -5.15), or virtual intervention delivery (median change = -4.65) were potential physiological, psychological, or situational influencing factors associated with anxiety improvement following mindfulness-based music therapy. Additional investigation into physiological, psychological, or situational influencing factors associated with anxiety response will help to tailor the design of future mindfulness-music therapy interventions to decrease psychological distress and address the unique psychosocial concerns among young adults receiving cancer treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT03709225.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Heather Woods
- The Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Carolyn S Phillips
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Katherine Thornton
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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15
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Ann-Yi S, Wong A, Wu J, Charone M, Baumgartner K, Carmack CL, Castro D, Guzman D, Joy M, Kuriakose L, Madden K, Najera J, Pangemanan I, Rajani S, Raznahan M, Stewart H, Tallie K, Tanco K, Zhukovsky D, Bruera E. Physical and Psychosocial Symptoms of Young Adult Patients Referred to the Supportive Care Mobile Team. J Adolesc Young Adult Oncol 2022. [PMID: 35881858 DOI: 10.1089/jayao.2022.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Young adult (YA) aged cancer patients have unique psychosocial needs with studies indicating more symptoms and emotional distress compared to older patients. Our study aimed to compare clinical characteristics and symptom distress between YAs and older adults. We retrospectively studied 896 randomly selected patients across 3 age groups: 18-39 YAs (n = 297), 40-64 (n = 300), and 65 and older (n = 299). We compared medical, psychosocial history, Morphine Equivalent Daily Dose (MEDD), Edmonton Symptom Assessment Scale (ESAS) scores, and Eastern Cooperative Oncology Group (ECOG) scores at the time of initial inpatient consultation with supportive care. YAs were more frequently female and white, with higher ECOG scores, had more self-reported psychiatric history and worse ESAS sleep scores compared to the other age cohort groups. YAs had higher pain expression than those of 65 years and older. YAs were more likely to have children younger than 18 years old, which was associated with worse pain, sleep, and financial distress. In general, YAs did not report higher symptoms distress, with the exception of insomnia and self-reported psychiatric history. Importantly, YAs with children was associated with higher ratings of pain, sleep difficulties, and financial distress. Overall, results suggest YAs may benefit from specialized services to address their unique psychosocial needs.
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Affiliation(s)
- Sujin Ann-Yi
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angelique Wong
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Jimin Wu
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maira Charone
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karen Baumgartner
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy L Carmack
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Debra Castro
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Guzman
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manju Joy
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Leela Kuriakose
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kevin Madden
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Najera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Imelda Pangemanan
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sabeena Rajani
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monica Raznahan
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Holly Stewart
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimmie Tallie
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberson Tanco
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donna Zhukovsky
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tsao Y, Kuo HC, Chen ZJ, Liou WS, Creedy DK. A longitudinal study to explore unmet care needs, social support and hope of women with gynaecological cancer. Nurs Health Sci 2022; 24:742-751. [PMID: 35841279 DOI: 10.1111/nhs.12975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/23/2022] [Accepted: 07/13/2022] [Indexed: 11/29/2022]
Abstract
The experience of a life-threatening illness, such as cancer, can have an array of health impacts and social and psychological well-being can be comprised. This study compared differences in unmet care needs, social support, and hope of Taiwanese women with either newly diagnosed (n = 72) or recurring (n = 39) gynaecological cancer at baseline (T0) and three follow-up surveys every two months (T1; T2; T3). Sociodemographic questions and three standardized self-administered questionnaires were used. The Generalized Estimating Equations (GEE) method was used to analyse data. Women with recurrent cancer reported higher levels of care needs and lower levels of hope than those with a primary diagnosis. Significant positive correlations between social support and hope scores were observed for women with recurring cancer at T1 and T2. However, these women reported less hope at T3 compared to those with a primary diagnosis. Routine assessment of women's care needs related to their medical condition and provision of different kinds of support can aim to improve well-being and their hope for the future.
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Affiliation(s)
- Ying Tsao
- Department of Nursing, Tzu Chi University, Hualien, Taiwan, Province of China
| | - Hoi-Chen Kuo
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Province of China
| | - Zon-Jen Chen
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Province of China
| | - Wen-Shiung Liou
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Province of China
| | - Debra Kay Creedy
- School of Nursing & Midwifery, Griffith University, Nathan, Queensland, Australia
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Feasibility and Acceptability of Bright IDEAS-Young Adults: A Problem-Solving Skills Training Intervention. Cancers (Basel) 2022; 14:cancers14133124. [PMID: 35804896 PMCID: PMC9264826 DOI: 10.3390/cancers14133124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Young adults with cancer are a vulnerable group with unique emotional, social, and practical needs. There is a lack of evidence-based interventions to address their needs and to foster skills that could increase their capacity to cope. Bright IDEAS is a problem-solving skills training intervention that has demonstrated efficacy in improving people's problem-solving ability and reducing distress among caregivers of children with cancer. This study evaluated the feasibility and acceptability of Bright IDEAS adapted for young adults (Bright IDEAS-YA). METHODS Forty young adults recently diagnosed with cancer were enrolled in a single arm feasibility study. RESULTS Feasibility was demonstrated by the adequate enrollment (67.8%), retention (80.0%), and participants' adherence to the intervention (average of 5.2 out of 6 sessions completed). Participants reported satisfaction with the intervention. Qualitative feedback identified the systematic approach to problem-solving and interaction with the trainer as strengths of the intervention. Participants demonstrated improvements in problem-solving skills and symptoms of depression and anxiety. CONCLUSIONS In conclusion, the results support the feasibility of the intervention and an adequately powered randomized controlled trial is needed to determine the efficacy of the intervention on psychosocial outcomes.
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18
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Knoerl R, Mazzola E, Woods H, Buchbinder E, Frazier L, LaCasce A, Li BT, Luskin MR, Phillips CS, Thornton K, Berry DL, Ligibel JA. Exploring the Feasibility of a Mindfulness-Music Therapy Intervention to Improve Anxiety and Stress in Adolescents and Young Adults with Cancer. J Pain Symptom Manage 2022; 63:e357-e363. [PMID: 34896280 DOI: 10.1016/j.jpainsymman.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
CONTEXT Adolescent and young adults (AYAs) with cancer experience significant psychological distress due to cancer treatment that can persist long after treatment. However, little is known regarding optimal interventions to support the psychosocial needs of AYAs with cancer. OBJECTIVE The overall objective of this single arm, longitudinal, pilot study was to determine the feasibility of implementing a mindfulness-based music therapy intervention to improve anxiety and stress in AYAs receiving cancer treatment. METHODS AYAs (15 - 39 years old) who were to receive cancer treatment for ≥ eight weeks were recruited from the pediatric, melanoma, sarcoma, breast, lymphoma, and leukemia oncology outpatient centers at Dana-Farber Cancer Institute. The music therapy intervention included four sessions of individual mindfulness-based music therapy in-person or using Zoom over twelve weeks. Prior to-and after the intervention period, participants completed the Patient-Reported Outcomes Measurement Information Anxiety 4a and Perceived Stress Scale. Changes in patient-reported outcomes are compared using Wilcoxon signed-rank tests. RESULTS Over ∼14 months, 37 of 93 eligible AYAs were enrolled to the study (39.8% consent rate). Overall, 27 of 37 (73%) participants (Median age=32; 56.8% Female) completed at least two music therapy sessions and the baseline measures and end of study measures. Participation in the mindfulness-based music therapy sessions resulted in significant pre-to-posttest improvements in perceived stress (median change: -4.0, P = 0.013) and non-significant changes in anxiety (median change: -1.9, P = 0.20). Satisfaction and acceptability were highly rated. CONCLUSIONS The delivery of a four-session mindfulness-based music therapy intervention to AYAs receiving chemotherapy was feasible and significantly improved perceived stress. These preliminary findings should be confirmed in a randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03709225.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services (R.K., C.S.P.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology (E.M.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather Woods
- The Leonard P. Zakim Center for Integrative Therapies and Healthy Living (H.W.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elizabeth Buchbinder
- Department of Medical Oncology (E.B., A.L., M.R.L., J.A.L.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lindsay Frazier
- Department of Pediatric Oncology (L.F.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ann LaCasce
- Department of Medical Oncology (E.B., A.L., M.R.L., J.A.L.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Belinda T Li
- School of Medicine (B.T.L.), Boston University, Boston, Massachusetts, USA
| | - Marlise R Luskin
- Department of Medical Oncology (E.B., A.L., M.R.L., J.A.L.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Carolyn S Phillips
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services (R.K., C.S.P.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Katherine Thornton
- Department of Medical Oncology (K.T.), Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics (D.L.B.), University of Washington, Seattle, Washington, USA
| | - Jennifer A Ligibel
- Department of Medical Oncology (E.B., A.L., M.R.L., J.A.L.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Broholm-Jørgensen M, Tjørnhøj-Thomsen T, Pedersen PV. Development of an intervention for the social reintegration of adolescents and young adults affected by cancer. BMC Public Health 2022; 22:241. [PMID: 35123447 PMCID: PMC8818212 DOI: 10.1186/s12889-022-12611-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Background In Denmark, around 500 adolescents and young adults (AYAs) aged 15–29 are diagnosed with cancer each year. AYAs affected by cancer constitute a vulnerable group in need of special support in pursuing everyday life as young people. These needs are, however, not currently being adequately met. This study explores the distinctive needs of AYAs aged 15–25 and affected by cancer with the aim of developing and designing an intervention that accommodates these needs and allows AYAs to pursue everyday life following active cancer treatment. Methods We combined multiple qualitative methods to conduct six sub-studies: 1) participant observation among support groups for AYAs affected by cancer, 2) field visit at a large Danish hospital, 3) qualitative interviews with AYAs currently or previously diagnosed with cancer, 4) qualitative interviews with practitioners working with young cancer patients or AYAs with chronic conditions, 5) an interactive workshop with practitioners, and 6) an interactive workshop with AYAs. The empirical material was collected between May 2016 and April 2019. The empirical material was read, analysed thematically and coded into the themes; 1) diagnosis and treatment, 2) form of education and 3) age, financial challenges and legal entitlements. Results Across the empirical material, we found that AYAs’ cancer experience was heterogeneous. The needs of AYAs differed according to 1) diagnosis and treatment, 2) type of education and 3) age, financial situation and legal entitlements. The findings demonstrate a need for a tailored intervention accommodating the variety of opportunities, requirements and challenges of AYAs with cancer. We propose an intervention consisting of a multidisciplinary team sited at the hospital where the individual AYA receives treatment. The team’s main task will be to maintain AYAs’ social competences and ease their return to everyday life after serious illness by balancing educational requirements with cancer treatment. Conclusion Based on the perspectives of practitioners and AYAs affected by cancer, this study outlines an intervention designed as a care pathway in which a multidisciplinary team provides individual and tailored support to AYAs with cancer from the time of diagnosis during and beyond active cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12611-4.
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Zhang A, Zebrack B, Acquati C, Roth M, Levin NJ, Wang K, Schwartz S. Technology-Assisted Psychosocial Interventions for Childhood, Adolescent, and Young Adult Cancer Survivors: A Systematic Review and Meta-Analysis. J Adolesc Young Adult Oncol 2022; 11:6-16. [PMID: 33960845 PMCID: PMC8864427 DOI: 10.1089/jayao.2021.0012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose: Technology-assisted interventions are essential in supporting cancer survivors' psychosocial outcomes, especially for childhood, adolescent, and young adult (AYA) cancer survivors, a tech-savvy generation. This study aims to systematically evaluate review and meta-analyze technology-assisted interventions for childhood and AYA cancer survivors. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, the study team used a pre-set of key words and searched studies across 11 electronic databases and 4 professional websites, and conducted a manual search of reference lists from published reviews. Meta-analysis of small sample size corrected Hedges' g was conducted using meta-regression with robust variance estimation. Results: Final analysis included a total of 28 clinical trials, including 237 effect sizes reported an overall statistically significant treatment effect of technology-assisted psychosocial interventions for childhood and AYA cancer survivors, g = 0.382, 95% confidence interval (CI) 0.243 to 0.521, p < 0.0001. Subgroup analysis revealed that distraction-based interventions and interventions for psychosocial and emotional health were overall statistically significant, whereas interventions for childhood and AYA cancer survivors' cancer knowledge outcomes and physical and functional health outcomes were statistically nonsignificant. Moderator analysis found intervention target was a significant moderator. Conclusions: Technology-assisted interventions for childhood and AYA cancer survivors were overall effective across domains of survivorship outcomes. Favorable evidence was found primarily for childhood cancer survivors with limited support for AYA cancer survivors. Implications for Cancer Survivors: Although existing technology-assisted interventions are overall promising, research support for cancer survivors from different age groups and with different psychosocial challenges varies and should be considered individually.
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Affiliation(s)
- Anao Zhang
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA.,Address correspondence to: Anao Zhang, PhD, MSW, University of Michigan School of Social Work, 1080 S. University Ave., Ann Arbor, MI 48109, USA
| | - Bradley Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Chiara Acquati
- University of Houston Graduate College of Social Work; and The University of Texas MD Anderson Cancer Center Department of Health Disparities Research, Houston, Texas, USA
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nina Jackson Levin
- University of Michigan School of Social Work, and Department of Anthropology, Ann Arbor, Michigan, USA
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Samantha Schwartz
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
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21
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Reinman L, Coons HL, Sopfe J, Casey R. Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors. CHILDREN 2021; 8:children8111058. [PMID: 34828771 PMCID: PMC8618923 DOI: 10.3390/children8111058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 01/23/2023]
Abstract
Adolescent and young adult (AYA) survivors of cancer have diverse psychosocial and medical needs, including those related to fertility and sexual health. Much of the focus of care around issues such as fertility and sexual health tends to be filtered through a biomedical lens. However, it is essential that health care providers assess and support AYA survivors using a biopsychosocial and contextual framework to ensure the most comprehensive and accurate understanding of AYA survivor needs, especially those related to psychosexual health. A trusting relationship between the multi-disciplinary medical team and the AYA survivor that allows for open discussion about the physical and psychosocial components of sexual health is key to providing best care and outcomes.
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Affiliation(s)
- Laura Reinman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- Correspondence:
| | - Helen L. Coons
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Jenna Sopfe
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (R.C.)
| | - Robert Casey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (R.C.)
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22
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Lehmann V, Laan ETM, den Oudsten BL. Sexual health-related care needs among young adult cancer patients and survivors: a systematic literature review. J Cancer Surviv 2021; 16:913-924. [PMID: 34669141 PMCID: PMC9300501 DOI: 10.1007/s11764-021-01084-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 01/05/2023]
Abstract
Purpose Young adult cancer patients and survivors have age-specific care needs, but care needs related to sexual health are poorly understood. A systematic literature review was conducted to examine sexual health-related care needs among patients/survivors diagnosed with cancer during young adulthood (age: 18–39 years). The prevalence and types needs were assessed along with associated patient factors. Methods Four major databases were screened to identify relevant studies, which were also assessed for risk of bias; all following PRISMA guidelines. Results Identified studies (N = 35) often assessed sexual health-related care needs by whether participants experienced a generic need for support from providers. The prevalence of such needs ranged between 8 and 61.7% and was higher in female survivors and those with more health impairments. The type of diagnosis could also play a role in these varying prevalence rates, but was not systematically tested in included studies. Types of sexual health-related care needs were clustered into practical/emotional support needs (e.g., coping with physical side effects), information needs (e.g., more details), and communication needs (e.g., providers should initiate conversations, validate concerns, be empathetic/open). Needs should be addressed in-person and/or online. Conclusions The extent of needs related to sexual health varies among young adult patients and survivors, but types of needs center around improving provision of support and information by providers. Implications for Cancer Survivors Sexual health should routinely be addressed alongside other potential effects of cancer treatment to allow for constructive conversations between patients and providers. Referrals to (online) resources or specialists should be tailored to individual preferences. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01084-w.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders, Tilburg University, Tilburg, Netherlands
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23
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Lidington E, Darlington AS, Din A, Stanway S, Banerjee S, Szucs Z, Gonzalez M, Sharma A, Sirohi B, van der Graaf WTA, Husson O. Describing Unmet Supportive Care Needs among Young Adults with Cancer (25-39 Years) and the Relationship with Health-Related Quality of Life, Psychological Distress, and Illness Cognitions. J Clin Med 2021; 10:jcm10194449. [PMID: 34640467 PMCID: PMC8509768 DOI: 10.3390/jcm10194449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022] Open
Abstract
Few studies describe supportive care needs among young adults (YAs) with cancer ages 25 to 39 using validated questionnaires. Previous findings identified the need for psychological and information support and suggest that gender, age, psychological distress, and coping may be associated with greater need for this support. To substantiate these findings, this study aimed to (1) describe the supportive care needs of YAs in each domain of the Supportive Care Needs Survey and (2) explore the relationship between unmet supportive care needs and clinical and demographic factors, health-related quality of life, psychological distress, illness cognitions, and service needs using latent class analysis. Clinical teams from six hospitals in England invited eligible patients to a cross-sectional survey by post. A total of 317 participants completed the survey online or on paper. YAs expressed the most need in the psychological and sexuality domains. Using latent class analysis, we identified three classes of YAs based on level of supportive care need: no need (53.3%), low need (28.3%), and moderate need (18.4%). In each class, median domain scores in each domain were similar. Low and moderate need classes were associated with worse health-related quality of life and greater helplessness. Unmet service needs were associated with the moderate-need class only. Patients with unmet supportive care needs should be offered holistic care across supportive care domains.
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Affiliation(s)
- Emma Lidington
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
| | - Anne-Sophie Darlington
- Health Sciences, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK; (A.-S.D.); (A.D.)
| | - Amy Din
- Health Sciences, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK; (A.-S.D.); (A.D.)
| | - Susannah Stanway
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
| | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK
| | - Zoltan Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Health Road, Ipswich IP4 5PD, UK;
| | - Michael Gonzalez
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, Hammersmith, London W6 8RF, UK;
| | - Anand Sharma
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood HA6 2RN, UK;
| | - Bhawna Sirohi
- Barts Health NHS Trust, St Bartholomew’s Hospital, W Smithfield, London EC1A 7BE, UK;
- Apollo Proton Cancer Centre, 4/661, Dr Vikram Sarabai Instronic Estate 7th St., Dr. Vasi Estate, Phase II, Tharamani, Chennai 600096, India
| | - Winette T. A. van der Graaf
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK; (E.L.); (S.S.); (S.B.); (W.T.A.v.d.G.)
- Department of Medical Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK
- Department of Medical Oncology, Netherlands Cancer Institute–Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Correspondence:
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24
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Schilstra CE, Sansom-Daly UM, Schaffer M, Fardell JE, Anazodo AC, McCowage G, Fletcher JI, Marshall GM, Buchhorn-White J, Evtushenko M, Trahair TN, Ellis SJ. "We Have All This Knowledge to Give, So Use Us as a Resource": Partnering with Adolescent and Young Adult Cancer Survivors to Determine Consumer-Led Research Priorities. J Adolesc Young Adult Oncol 2021; 11:211-222. [PMID: 34297633 DOI: 10.1089/jayao.2021.0052] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: Involvement of adolescent and young adult (AYAs) cancer survivors as consumers in research is increasingly encouraged, yet few studies have identified the feasibility and acceptability of methods used to involve them. We aimed to identify: (1) How feasible and acceptable is a consumer-driven, workshop-based research priority-setting approach? And (2) what research priorities do Australian AYA consumers endorse? Methods: AYA cancer survivors diagnosed 15-30 years old and currently younger than 35 years were invited to participate. The AYAs completed a pre-workshop survey to rank their top three priorities from the United Kingdom-based James Lind Alliance list, participated in a 90-minute focus group, and completed a post-workshop evaluation survey. We assessed the workshop feasibility by reviewing considerations, challenges, and enablers of success in the planning and conduct processes. Acceptability was assessed through participants' evaluation surveys and facilitators' informal reflections. The top three priorities were determined from pre-workshop surveys and focus group data. Results: Six survivors participated (M age = 24.2 years, M = 5 years post-treatment, 83% female). All reported that the workshop was an acceptable way to engage with researchers. Costs and recruitment challenges limited the workshop's feasibility. The AYAs' top priority was: What psychological support package improves psychological well-being, social functioning, and mental health during and after treatment? Discussion: The AYA survivors found our workshop to be an acceptable way to engage in research priority-setting. However, the feasibility of this approach depends on the resources available to researchers. Future research is needed to define the optimal method of engagement: What is most acceptable for AYAs and feasible for researchers?
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Affiliation(s)
- Clarissa E Schilstra
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Maria Schaffer
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Youth Cancer Services, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia
| | - Antoinette C Anazodo
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Geoffrey McCowage
- The Cancer Centre for Children, Children's Hospital at Westmead, Westmead, Australia
| | - Jamie I Fletcher
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, Australia
| | - Glenn M Marshall
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Children's Cancer Institute, Lowy Cancer Centre, UNSW Sydney, Kensington, Australia.,The Kids Cancer Alliance, Cancer Institute NSW, Kensington, Australia
| | | | | | - Toby N Trahair
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah J Ellis
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,School of Psychology, Faculty of Science, University of Sydney, Camperdown, Australia
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25
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Folbrecht J, Mayorga L, Fulginiti K, Trujillo M, Joshi R, Namm J, Kelly N. Reduction of Distress and Attrition in a 6-Week Psychoeducational Group: A Pilot Study. J Adolesc Young Adult Oncol 2021; 11:56-60. [PMID: 33877913 DOI: 10.1089/jayao.2021.0030] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: The distress and unique needs of AYAs (adolescent/young adults) with an oncology diagnosis have been well explored and documented in the literature. However, effective means of reducing distress and meeting needs has been more elusive. This study explored the impact of a 6-week psychoeducational pilot group on AYA distress. Methods: Patient surveys and literature review were conducted to develop content for a 6-week psychoeducational group to reduce AYA distress through peer support and increased knowledge related to symptom management, physician communication, body image, family relationships, autonomy, sexuality, fertility, and coping skills. Distress was measured using the Hospital Anxiety and Depression Scale (HADS). Results: Twenty-one AYAs receiving oncology treatment enrolled in the group. Thirteen completed the program. Reasons for attrition included transportation, severity of symptoms, procedures, disinterest, and death. A correlated t-test demonstrated a significant decrease in HADS total score from pre- to post-test. Conclusion: This pilot study suggests that providing AYAs with information relative to their unique developmental needs and opportunities to process those needs in an environment of peers is challenging but can have benefit. nCT01817335.
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Affiliation(s)
- Jeanelle Folbrecht
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Lina Mayorga
- Department of Clinical Research, Methodist Hospital of Southern California
| | | | - Marisol Trujillo
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Renee Joshi
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - JoAnn Namm
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Natalie Kelly
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
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26
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Sender A, Friedrich M, Leuteritz K, Stuckenberg E, Richter D, Stöbel-Richter Y, Lordick F, Geue K. Psychosocial aftercare of adolescent and young adult cancer survivors in Germany: Awareness, utilisation, satisfaction and associated factors. Psychooncology 2021; 30:1311-1321. [PMID: 33739567 DOI: 10.1002/pon.5678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/10/2022]
Abstract
AIM This study systematically assesses the awareness of, utilisation of and satisfaction with psychosocial care for adolescents and young adult (AYA) cancer survivors in aftercare. METHODS Survivors between 18 and 39 years were surveyed in aftercare. Awareness of, utilisation of and satisfaction with psychological counselling (PC), social-legal counselling (SLC) and other psychosocial care (OPC) were measured using self-developed questionnaires. Multivariate analyses were conducted to determine factors correlated with awareness and use of psychosocial care. RESULTS Five hundred and fourteen survivors participated; the mean age at diagnosis was 29.6 years (SD = 6.14). 54% of cancer survivors were aware of PC, 45% of SLC and 24% of OPC. Those who possessed knowledge about these services used it to a considerable extent (63%-74%), and the majority (66%-75%) was highly satisfied. No common factors could be found that increase the likelihood of being aware of these three services (R2 = 0.028-0.138). Female gender (OR = 2.08-2.18) and high anxiety (OR = 1.19-1.38) were identified as common factors that increase the likelihood of utilising psychosocial services (R2 = 0.160-0.395). CONCLUSION AYA who are aware of psychosocial services in aftercare are motivated to use them and express high satisfaction with use. For the utilisation of psychosocial services, anxiety and female gender can be identified as common factors. The visibility of psychosocial services for aftercare should be increased given the high number of unaware AYA survivors. The active and repeated addressing of psychosocial issues and regular provision of information (e.g., written guides on survivorship) by caregivers should be made a standard of care for AYA cancer survivors.
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Affiliation(s)
- Annekathrin Sender
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Katja Leuteritz
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Erik Stuckenberg
- St. Elisabeth and St. Barbara Hospital, Medical Clinic II, Halle (Saale), Germany
| | - Diana Richter
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Yve Stöbel-Richter
- University of Leipzig, Integrated Research and Treatment Center, Behavioral Medicine, Leipzig, Germany.,University of Zittau/Goerlitz, Faculty of Managerial and Cultural Studies, Goerlitz, Germany
| | - Florian Lordick
- University of Leipzig, Medical Center, University Cancer Center Leipzig, Leipzig, Germany
| | - Kristina Geue
- Department of Mental Health, Medical Psychology & Medical Sociology, University of Leipzig, Leipzig, Germany
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27
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Telles CM. A scoping review of literature: What has been studied about adolescents and young adults (AYAs) with cancer? Cancer Treat Res Commun 2021; 27:100316. [PMID: 33545568 DOI: 10.1016/j.ctarc.2021.100316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To map, organize and analyze the articles published in the last five years about AYAs with cancer. METHODS CAPES database and Google Scholar were searched to identify relevant studies from 2015 to February 2020. Eligible articles included empirical or theoretical research, quantitative and/or qualitative studies, targeted AYAs with cancer, addressed different topics related to AYAs such as unmet needs, hospital challenges, interventions or tools based on evidence, as well as political and socioeconomic aspects. RESULTS Of the 161 articles analyzed, 74 (46%) discussed the health system, including hospital dynamics, treatment and interventions during treatment; 63 (39.1%) discussed aspects or interventions that influence the quality of life and mental health of AYAs with cancer; 14 (8.7%) discussed issues related to sexual health; and 10 (6.2%) addressed social, economic and demographic problems of AYAs with cancer. Three types of purposes have been identified in the articles: 118 (73.3%) investigated variables in areas related to AYAs with cancer, aiming to increase the understanding of the phenomenon and the needs of AYAs; 18 (11.2%) intervened on the needs of AYAs with cancer through pilot studies or evidence-based interventions; and 22 (13.7%) aimed to evaluate an intervention previously performed or to evaluate an intervention based on evidence. CONCLUSION There is still much to be researched within the last two categories. In the last three years, these categories have been growing gradually and on a small scale.
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Affiliation(s)
- Camila M Telles
- Graduating in Psychology - Senior year, Positivo University - Curitiba, Paraná, Brazil (Student); Teen Cancer America - Los Angeles, California, the United States of America (Intern Pro Cancer).
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28
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Okamura M, Fujimori M, Sato A, Uchitomi Y. Unmet supportive care needs and associated factors among young adult cancer patients in Japan. BMC Cancer 2021; 21:17. [PMID: 33402126 PMCID: PMC7786954 DOI: 10.1186/s12885-020-07721-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Young adult cancer patients often face unique challenges and have potential unmet needs. This study aimed (1) to describe unmet supportive care needs among young adults with cancer in Japan, and (2) to identify its associated factors. Methods In a cross-sectional web-based survey, 206 young adults with cancer were assessed for supportive care needs. Multiple regression analysis examined whether demographics, clinical variables and social support were associated with unmet supportive care needs. Results A total of 206 patients (180 female) with a mean age of 33.7 years (SD = 4.3, range: 22–39) participated. One hundred and fifty-eight participants (76.7%) reported at least one unmet supportive care needs. The top 20 unmet needs included 9 of the 10 psychological needs, 3 of the 5 physical and daily living needs, 8 of the 11 health system and information needs and 1 of the 5 sexuality needs. Multiple regression analysis revealed that perceived poorer PS, experience of change in work/school after a cancer diagnosis and poor social support were significantly associated with higher supportive care needs. The total score of supportive care needs was significantly associated with both psychological distress and QOL. Conclusions More than 70% of young adult cancer patients reported unmet supportive care needs and most of those were psychological needs. The findings suggest potential opportunities for intervention in addressing psychological needs rather than physical and information needs.
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Affiliation(s)
- Masako Okamura
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Maiko Fujimori
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan. .,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan.
| | - Ayako Sato
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Uchitomi
- Division of Behavioral Science Research, Behavioral Sciences and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
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29
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Gao Y, Zhu L, Xie J, Liu A, Ding Y, Yao J. Unmet needs from the first diagnosis of cancer until the end of medical treatment: A longitudinal study. Psychooncology 2020; 30:554-563. [PMID: 33232546 DOI: 10.1002/pon.5602] [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: 06/30/2020] [Revised: 10/31/2020] [Accepted: 11/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to examine (1) The courses of Chinese cancer patients' unmet supportive care needs (psychological, physical and daily living, health system and information, patient care and support, and sexual) from the first cancer diagnosis until the end of medical treatment; (2) The predictive role of socio-demographic and medical characteristics (i.e., age, gender, and cancer stage) in the courses of unmet needs; and (3) The associations of courses of unmet needs with courses of depressive and anxiety symptoms. METHODS A longitudinal study was performed at Shaanxi Provincial Tumour Hospital in Xi'an, China. A total of 153 heterogeneous cancer patients were assessed after the first diagnosis (T1), at the beginning (T2) and the end (T3) of the receipt of medical treatment. Latent growth curve models were used to examine the research questions. RESULTS Psychological needs and health system and information needs showed a decrease over time, whereas physical needs, patient care needs and sexual needs remained stable. Younger and female patients tended to report higher levels of unmet psychological needs at T1 and experienced slower decreases from T1 to T3. Only the courses of unmet psychological needs were associated with the courses of depressive and anxiety symptoms from T1 to T3. CONCLUSIONS More attention can be given to young and female cancer patients, as they were more likely to suffer from high unmet psychological needs over the disease trajectory. Future research may focus more on addressing unmet needs reported by Chinese cancer patients.
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Affiliation(s)
- Yuhan Gao
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Lei Zhu
- School of Psychology, Shaanxi Normal University, Xi'an, Shaanxi, China
| | - Juan Xie
- Shaanxi Provincial Tumour Hospital, Xi'an, Shaanxi, China
| | - Ailan Liu
- Shaanxi Provincial Tumour Hospital, Xi'an, Shaanxi, China
| | - Yanni Ding
- Shaanxi Provincial Tumour Hospital, Xi'an, Shaanxi, China
| | - Juntao Yao
- Shaanxi Provincial Tumour Hospital, Xi'an, Shaanxi, China
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30
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Vandraas KF, Reinertsen KV, Kiserud CE, Lie HC. Fear of cancer recurrence among young adult cancer survivors-exploring long-term contributing factors in a large, population-based cohort. J Cancer Surviv 2020; 15:497-508. [PMID: 32989672 PMCID: PMC8272704 DOI: 10.1007/s11764-020-00943-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Fear of cancer recurrence (FCR) may be debilitating, yet knowledge of FCR among the growing population of long-term young adult cancer survivors (YACS) is scarce. We explored risk of FCR and associated factors in a nation-wide, population-based cohort of YACS. METHODS All 5-year survivors diagnosed at the ages of 19-39 years with breast cancer (BC), malignant melanoma (MM), colorectal cancer (CRC), leukemia (LEU), or non-Hodgkin lymphoma (NHL) between 1985 and 2009 in Norway were identified by the Cancer Registry of Norway and completed the cross-sectional comprehensive NOR-CAYACS health survey. Univariate and multivariate linear regression modeling was performed. RESULTS In total, 936 survivors were included, with an average of 16 years since diagnoses. BC was the most prevalent cancer form (38.4%), followed by MM (24.7%), NHL (15.6%), CRC (11.8%), and LEU (9.6%). Survivors worried most about getting another cancer (74%), and (20%) reported quite a bit or a lot of FCR. BC and MM survivors had the highest FCR scores. Post-traumatic stress symptoms (PTSS) had the strongest association with FCR (Std B 0.21, p < 0.01), above demographic and clinical variables. CONCLUSIONS FCR is prevalent even among long-term YACS, including survivors of MM with favorable prognoses. IMPLICATIONS FOR CANCER SURVIVORS Attention to ongoing risks of PTSS and FCR in this growing survivor population is warranted to optimize future survivorship care.
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Affiliation(s)
- Kathrine F Vandraas
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
| | - Kristin V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Hanne C Lie
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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31
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Ren JY, Zhong JD, Yuan J, Zhang JE, Li CZ, Wei WJ. Unmet supportive care needs and associated factors among Chinese discharged patients with esophageal cancer after esophagectomy: A cross-sectional study. Eur J Oncol Nurs 2020; 46:101767. [PMID: 32504878 DOI: 10.1016/j.ejon.2020.101767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE After esophagectomy, patients experience a series of problems that severely affect their quality of life. Understanding their unmet needs could help medical staff provide better supportive care. The aim of this study was to investigate the supportive care needs of discharged patients with esophageal cancer after esophagectomy and explore the factors associated with these needs. METHOD A total of 167 discharged patients with esophageal cancer after esophagectomy were recruited from a University Cancer Center in China and investigated using a self-designed demographic and clinical characteristics questionnaire, the 34-item Supportive Care Needs Survey, and the M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module. RESULTS Approximately 95.2% of the patients had ≥1 unmet need(s). The overall level of supportive care needs of patients after esophagectomy was mild to medium. Most of the top 10 moderate-to-severe unmet needs were identified in the health and information domains. Age (β = -0.157, p = 0.011), dysphagia (β = -0.178, p = 0.005), recurrence (β = 0.175, p = 0.005), time since diagnosis (β = -0.150, p = 0.018), and symptom interference (β = 0.488, p < 0.001) were significantly associated with supportive care needs. CONCLUSIONS Discharged patients with esophageal cancer after esophagectomy had a wide range of unmet supportive care needs. It is essential to combine the associated factors to accurately evaluate patient needs. We should pay more attention to propose comprehensive measures for these patients and provide more individualized supportive care during the lengthy recovery period.
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Affiliation(s)
- Jin Ying Ren
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Jiu Di Zhong
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Juan Yuan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun E Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Chuan Zhen Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Jin Wei
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Murphy A, Chu RW, Drummond FJ. A cost analysis of a community-based support centre for cancer patients and their families in Ireland: the EVeCANs study. Support Care Cancer 2020; 29:619-625. [PMID: 32415384 DOI: 10.1007/s00520-020-05508-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/01/2020] [Indexed: 11/25/2022]
Abstract
Cancer patients and their families experience a range of physical, psychological and financial adverse effects. Community-based cancer centres offer a range of services and interventions, free of charge, to support those affected by cancer. While shown to be effective, there is a lack of information on the costs of these services. Our aim was to estimate the resource impact of a community-based cancer support centre. Over a 7-month period, there were 2032 contacts with 238 clients whose average age was 60 years. The most frequently used services were transport to treatment (20%), complementary therapies (48%), exercise classes (10%) and counselling (9%). This cost analysis estimated total annual cost to provide all services was €313,744. Average annual cost per person was €1138. Current uptake at the centre represents 8% of all cancer incidences in seven counties surrounding the centre. If uptake increases by 10%, scenario analyses predict an increase in total costs increase to €429,043 and a decrease in costs per patient to €915. As cancer incidences increase, the need for supportive care is growing. Community-based services have been established to meet these needs and fill this gap in national health services. Long-term sustainability of these centres is uncertain as they are entirely reliant on donations and volunteers. This analysis estimates the costs of one such community-based cancer support centre, for the first time in Ireland. Findings can be used to inform future planning of cancer supportive care services, including establishing links between tertiary and community-based centres, and cost effectiveness analyses, nationally and internationally.
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Affiliation(s)
- Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
| | - Ryan W Chu
- School of Medicine, University College Cork, Cork, Ireland
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Kaluarachchi T, McDonald F, Patterson P, Newton-John TRO. Being a teenager and cancer patient: What do adolescents and young adults with cancer find valuable and challenging with their friends and cancer peers? J Psychosoc Oncol 2019; 38:195-209. [PMID: 31608828 DOI: 10.1080/07347332.2019.1672847] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: This study examined Adolescent and Young Adult (AYA) cancer patients' experiences with friends and cancer friends (peers) throughout their cancer journey.Research approach: Qualitative, thematic analysis.Participants: Twelve AYA diagnosed with cancer, treated within the past five years.Methodological approach: Individual semi-structured interviews, focusing on friend and peer experiences pre-/post-diagnosis, during and after treatment.Findings: Overarching themes of 'valued' vs. 'challenging' aspects with friends and peers.Interpretation: Friend and peer relationships were both valuable, but in different ways. Friends provided general support and helped AYA feel like a normal teenager, while peers provided targeted support and helped AYA feel like a normal teenager with cancer. Peers had an intimate understanding of cancer, whereas poor understanding by friends led to further challenges such as avoidance and being dismissive. Peer relations were notably challenged by a premature confrontation with mortality. Friendships evolved and changed throughout the cancer journey.
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Affiliation(s)
| | - Fiona McDonald
- Research, Evaluation & Social Policy, CanTeen Australia, Sydney, Australia
| | - Pandora Patterson
- Research, Evaluation & Social Policy, CanTeen Australia, Sydney, Australia
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