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Martin EG, Kuziek J, Rasiah J, Orr SL. Evaluating patient and family preferences for acute and preventive pediatric headache treatment. Headache 2024. [PMID: 38828670 DOI: 10.1111/head.14739] [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: 10/30/2023] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To describe acute and preventive treatment preferences among youth with migraine and their parents/guardians, and to describe the degree of youth-parent/guardian preference agreement. BACKGROUND Headache disorders are common in youth, but little is known about patient and family preferences for headache treatments and outcomes. METHODS In this cross-sectional survey, a headache treatment preferences questionnaire was co-created with stakeholders, piloted, and distributed to consenting youth with migraine aged 9-18 years and parents/guardians at a tertiary care headache clinic in western Canada. Response data were summarized for youth and parents/guardians separately, and agreement rates within a youth-parent/guardian pair were compared to a hypothesized agreement rate of 80% for the primary questionnaire items. RESULTS Seventy-two youth and n = 94 parents/guardians participated, with n = 63 in youth-parent/guardian pairs. Freedom from pain and rapid relief, and reducing pain severity and headache frequency were top acute and preventive treatment priorities, respectively. More than 90% (69/72) agreed that ≥ 50% reduction in headache frequency was a good target. For both acute and preventive interventions, swallowed pill-based options were most often selected as the preferred first-line treatment, with neuromodulation selected as the preferred second-line treatment. The level of agreement within youth-parent/guardian pairs on preferred treatment modalities was lower than hypothesized for acute (63% [40/63], 95% confidence interval [CI] = 52-75%, χ2 = 10.73, p = 0.001) but not for preventive treatment (73% [46/63], 95% CI = 62-84%, χ2 = 1.92, p = 0.166). Regarding which treatment modalities were perceived as most effective, youth-parent agreement was lower than hypothesized for both acute (48% [30/63], 95% CI = 35-60%, χ2 = 41.29, p < 0.001) and preventive treatment (46% [29/63], 95% CI = 34-58%, χ2 = 45.43, p < 0.001). CONCLUSION Youth and family preferences aligned qualitatively, but sometimes diverged quantitatively, from typical clinical trial outcomes. The level of agreement within youth-parent/guardian pairs on treatment preferences and perceptions was low. Clinicians should consider both perspectives as they may be divergent.
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Affiliation(s)
- Elise G Martin
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Kuziek
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jananee Rasiah
- Alberta Strategy for Patient Oriented Research Support Unit, Patient Engagement Platform, Calgary, Alberta, Canada
- Faculty of Nursing, MacEwan University, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Loecher N, Jordan A, Spunt SL, Simon P, Simons LE, Dahl G, Kosyluk K, Heathcote LC. "You don't accept he's completely ok": a reflexive thematic analysis of parents' roles in monitoring their child's health and symptoms after finishing childhood cancer treatment. J Cancer Surviv 2024; 18:950-959. [PMID: 36821041 DOI: 10.1007/s11764-023-01353-w] [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: 11/20/2022] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES/PURPOSE Childhood cancer survival brings continued mental and physical health challenges both for the child and for the family. In this study, we investigated how parents viewed their roles in their child's health and symptom monitoring during the survivorship period. METHODS Twenty-one parents of childhood cancer survivors (n = 18 mothers; parent mage = 49.78 years, child mage = 18.50 years; range = 12-25 years), whose children were at least one year off-treatment (m = 3.67 years; SD = 2.25; various diagnoses), completed semi-structured interviews. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. RESULTS Analyses generated three themes which reflect roles that parents may adopt in the context of monitoring symptoms in their childhood cancer survivor. "Vigilant Mama and Papa" (theme 1) described parents who expressed a strong sense of responsibility for protecting their child's health during survivorship resulting in careful monitoring of their child's symptoms and health. "Pragmatic Mamas and Papas" (theme 2) described parents who adopted an approach to symptom and health monitoring that emphasized moving past cancer and focusing on the future. Finally, "Encouraging Mamas and Papas" (theme 3) described parents who focused on educating and preparing their child to develop an autonomous approach to health and symptom self-monitoring as they transitioned to survivorship and adulthood. CONCLUSION Parents take on varying roles in monitoring their child's symptoms and health after finishing childhood cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS Understanding the ways in which parents continue to be involved in their child's cancer journey helps researchers develop interventions to support dyadic coping in survivorship.
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Affiliation(s)
- Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, 33613, USA.
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela Simon
- Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary Dahl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA
| | - Kristin Kosyluk
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, 33613, USA
| | - Lauren C Heathcote
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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Larsen EH, Wahl AK, Ruud E, Mellblom AV, Ålykkja A, Lie HC. Adolescent Cancer Survivors and Their Parents' Experiences With the Transition Off Treatment to Survivorship: A Qualitative Interview Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:172-187. [PMID: 38656765 DOI: 10.1177/27527530231214528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Transitioning from active cancer treatment to survivorship represents a vulnerable yet underresearched phase for adolescents and their families. Knowledge of their support needs, the challenges they experience, and how they manage them are useful to inform tailored follow-up care. Thus, we aimed to explore their transition experiences. Method: We interviewed 15 adolescents (12-19 years) who had transitioned off of treatment 1 to 47 months prior at Oslo University Hospital's Department of Paediatric Haematology and Oncology and their biological parents (n = 16). The interviews were analyzed using inductive, reflexive thematic analysis inspired by Braun and Clarke. NVivo-12 was used for data management. Results: Four main themes were identified: (a) consequences of cancer beyond transition, (b) transition back to normalcy, (c) survivorship competence, and (d) changes in roles and relationships. The families described happiness and relief but also said that the lingering effects of cancer treatment had a profound impact on day-to-day living. The adolescents expressed closeness with and dependency on their parents, and they perceived family and friends as essential for social readjustment. Discussion: Although adolescent survivors and their parents described a wide variety of strategies for returning to "normalcy," their perspectives also illustrate ongoing psychosocial and educational support needs that changed over time. Our findings indicate a need for improved preparation for and support through the transition. Nurses are well positioned to provide continuous and structured transition support tailored to the needs of the individual survivors and their families.
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Affiliation(s)
- Elna Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Anneli Viktoria Mellblom
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Nydalen, Oslo, Norway
| | - Anette Ålykkja
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
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Jeon KH, Shin DW, Lee JW, Baek HJ, Chung NG, Sung KW, Song YM. Parent caregivers' preferences and satisfaction with currently provided childhood cancer survivorship care. J Cancer Surviv 2024; 18:617-630. [PMID: 36396908 DOI: 10.1007/s11764-022-01287-9] [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: 09/17/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to investigate the level of satisfaction of parent caregivers of childhood cancer survivors (CCSs) with currently provided survivorship care and their preferences for survivorship care provider. METHODS Study subjects were parent caregivers recruited at three hospitals in Korea. Study data were collected from self-administered questionnaires and medical records. We assessed parent caregivers' levels of satisfaction with specific survivorship care contents and preferred types of survivorship care provider among oncologists, primary care physicians (PCPs), and institutional general physicians (IGPs). Factors associated with parent caregivers' preferences for survivorship care provider were evaluated by multiple logistic regression analysis. RESULTS 680 parent caregivers (mother 62.1% and father 37.9%) of 487 CCSs (mean age at diagnosis: 6.9 ± 5.1 years; mean time since treatment completion 5.4 ± 4.4 years) were included. Parent caregivers' dissatisfaction was the highest with screening for second primary cancer, followed by psychosocial problem management. Higher educational level of parent caregiver, parent caregiver's higher level of dissatisfaction with currently provided care, higher age of CCSs at cancer diagnosis, history of receiving hematopoietic stem cell transplant, and longer time lapse after cancer treatment were significantly associated with parent caregivers' higher preference for PCPs or IGPs than oncologists. Parent caregiver's multiple comorbidities and higher fear of cancer recurrence were associated with parent caregivers' higher preference for oncologists than PCPs or IGPs. Around 80% of parent caregivers recognized that a shared care system was helpful for promoting the health of CCSs. CONCLUSION Parent caregivers were substantially dissatisfied with currently provided care, especially regarding the health issues not directly associated with the primary cancer. Parent caregivers' preferences for survivorship care provider is influenced by multiple factors, including age and survival time of CCSs, characteristics of parent caregivers, satisfaction level with care, and specific survivorship care contents. IMPLICATIONS FOR CANCER SURVIVORS The findings of our study suggest that shared survivorship care for CCSs with consideration of specific care contents can complement the current oncologist-led survivorship care system.
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Affiliation(s)
- Keun Hye Jeon
- Department of Family Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Donggu, Gwangju, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, the Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Kluczynski MA, Rodriguez EM, McGillicuddy CS, Schlecht NF. Human Papillomavirus Vaccination in Pediatric, Adolescent, and Young Adult Cancer Survivors-Opportunity to Address Gaps in Cancer Prevention and Survivorship. Vaccines (Basel) 2024; 12:114. [PMID: 38400098 PMCID: PMC10892003 DOI: 10.3390/vaccines12020114] [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: 11/07/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
The risks of secondary cancers associated with human papillomavirus (HPV) infection are as much as three times higher for survivors of pediatric, adolescent, and young adult cancer (PYAC) compared to the general population. Despite this, HPV vaccination rates among PYAC survivors remain low. Whereas pediatric oncology providers endorse HPV vaccination of PYAC survivors, many lack the resources or opportunities to intervene. The responsibility of HPV vaccination, therefore, falls to primary care providers and practices. This article provides an overview of the challenges with HPV vaccination that are distinct to PYAC survivors and discusses potential strategies to increase HPV vaccine coverage in this population.
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Affiliation(s)
| | | | | | - Nicolas F. Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.A.K.); (E.M.R.); (C.S.M.)
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Ma J, Xiao X, Zhou S, Gu C, Liu F, Wang H. Features of Studies on Transition Interventions for Childhood Cancer Survivors: A Scoping Review. Cancers (Basel) 2024; 16:272. [PMID: 38254763 PMCID: PMC10814357 DOI: 10.3390/cancers16020272] [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: 11/03/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE in this scoping review, previously reported data were described and synthesized to document transition interventions in CCSs, and the features of intervention components of the current transition studies for CCSs were summarized. METHODS A literature search was conducted in PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid, and the Cochrane Library following the PRISMA-ScR statement. All original studies (n = 9) investigating transition interventions in CCSs were included. RESULTS The current studies identified essential elements for transition programs, such as delivering knowledge, developing skills for coordination of care, and addressing psychosocial needs. However, the current transition interventions were generally in their infancy, and major deficits were found, including poorly reported intervention components and procedures, a limited number of relevant validated outcomes, and a failure to incorporate conceptual frameworks and international consensus statements. CONCLUSIONS This scoping review mapped current evidence of transition interventions for CCSs and highlighted the paucity of data in this area. More high-quality and well-reported randomized controlled trials are needed for the enrichment and standardization of future transition interventions.
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Affiliation(s)
- Jun Ma
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Siqi Zhou
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Can Gu
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
| | - Fei Liu
- Department of Pediatric Hematology Oncology, The Xiangya Hospital, Central South University, Changsha 410008, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha 410013, China; (J.M.); (X.X.); (S.Z.); (C.G.)
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7
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Jin AH, Simon PJ, Clayton A, Benedict C, Liedtke M, Muffly L, Schapira L, Smith SM. Implementation of a Pilot Clinic for Pediatric to Adult Cancer Survivorship Transitions. J Adolesc Young Adult Oncol 2023; 12:918-922. [PMID: 37615593 DOI: 10.1089/jayao.2023.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Childhood cancer survivors are recommended to have lifelong survivorship care, yet many become disengaged during pediatric to adult care transitions. We implemented a pilot clinic for adult survivors of pediatric or adolescent and young adult (AYA) leukemia transitioning to adult-focused survivorship care. The clinic featured AYA-specific care, bidirectional communication with primary care, and a quality improvement (QI) cycle. During the 1-year QI period, 27 patients were seen and 21 completed postvisit interviews. The clinic was positively received by patients and primary care providers, showed promise for improving self-management and care coordination, and highlighted the need for novel approaches to connect survivors with primary care.
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Affiliation(s)
| | - Pamela J Simon
- Lucile Salter Packard Children's Hospital at Stanford, Stanford Adolescent and Young Adult Cancer Program, Palo Alto, California, USA
| | - Alison Clayton
- Lucile Salter Packard Children's Hospital at Stanford, Stanford Adolescent and Young Adult Cancer Program, Palo Alto, California, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michaela Liedtke
- Divisions of Hematology, Department of Medicine, Stanford Health Care, Stanford, California, USA
| | - Lori Muffly
- Blood and Marrow Transplantation and Cellular Therapy, Department of Medicine, Stanford Health Care, Stanford, California, USA
| | - Lidia Schapira
- Oncology, Department of Medicine, Stanford Health Care, Stanford, California, USA
- Stanford Cancer Institute, Stanford, California, USA
| | - Stephanie M Smith
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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von Werthern M, Sweet R, Tsipa A, Caliskan I, Clements H, Alcock K, Soon K. Endings and the end of treatment bell in paediatric cancer treatment for acute lymphoblastic leukaemia: An interpretative phenomenological analysis of children's perspectives. J Cancer Policy 2023; 38:100442. [PMID: 37648153 DOI: 10.1016/j.jcpo.2023.100442] [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: 01/10/2023] [Revised: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
Advancements in paediatric oncology have made quality of life after cancer increasingly clinically important. Little is currently known about children's experiences of treatment completion and its management. AIM The current study explores children's experience of ending treatment for Acute Lymphoblastic Leukaemia (ALL), and the meaning it is given, particularly how endings are signified and marked. METHOD Semi-structured interviews were conducted with seven children who had completed cancer treatment for ALL with good prognoses. Interviews were analysed using Interpretative Phenomenological Analysis. RESULTS Five superordinate themes were generated: 'the end is always there', 'the punctuation of endings', 'that which is remembered, that which is forgotten', 'the voiced and the unvoiced', and 'freedom from cancer.' CONCLUSION Children highlighted the importance of punctuating and celebrating the end of their treatment, and the need for doing this in ways that helped them process the complexity of ending active treatment and provides space for their voices.
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Affiliation(s)
- Martha von Werthern
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Rebecca Sweet
- Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - Anastasia Tsipa
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Izel Caliskan
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Henry Clements
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Kat Alcock
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Kristina Soon
- University College London, Research Department of Clinical, Educational and Health Psychology, 1-19 Torrington Place, London WC1E 6BT, UK; Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
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Badour B, Bull A, Gupta AA, Mirza RM, Klinger CA. Parental Involvement in the Transition from Paediatric to Adult Care for Youth with Chronic Illness: A Scoping Review of the North American Literature. Int J Pediatr 2023; 2023:9392040. [PMID: 38045800 PMCID: PMC10691897 DOI: 10.1155/2023/9392040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023] Open
Abstract
With medical advancements and improvements in medical technology, an increasing number of children with chronic conditions survive into adulthood. There is accordant growing interest toward supporting adolescents throughout the transition from paediatric to adult care. However, there is currently a paucity of research focusing on the role that these patients' parents should play during and after the transition to adult care and if maintained parental involvement is beneficial during this transition within a North American context. Accordingly, this scoping review utilized Arksey and O'Malley's five-step framework to consider parental roles during chronically ill children's transition to adult care. APA PsycInfo, CINAHL, EMBASE, MEDLINE, ProQuest, and Scopus were searched alongside advanced Google searches. Thematic content analysis was conducted on 30 articles meeting the following inclusion criteria: (1) published in English between 2010 and 2022, (2) conducted in Canada or the United States, (3) considered adolescents with chronic conditions transitioning to adult care, (4) family being noted in the title or abstract, and (5) patient populations of study not being defined by delays in cognitive development, nor mental illness. Three themes emerged from the literature: the impacts of maintaining parental involvement during transition to adult care for patients, parents experiencing feeling loss of stability and support surrounding the transition of their child's care, and significant nonmedical life events occurring for youths at the time of transition of care. Parents assuming supportive roles which change alongside their maturing child's needs were reported as being beneficial to young peoples' transition processes, while parents who hover over or micromanage their children during this time were found to hinder successful transitions. Ultimately, the majority of reviewed articles emphasized maintained parental involvement as having a net positive impact on adolescents' transitions to adult care. As such, practice and policies should be structured to engage parents throughout the transition process to best support their chronically ill children during this time of change.
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Affiliation(s)
- Bryn Badour
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Amanda Bull
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Abha A. Gupta
- Temerty Faculty of Medicine: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
- Division of Medical Oncology, University Health Network: Princess Margaret Cancer Centre, Toronto, Ontario, Canada M5G 2C1
| | - Raza M. Mirza
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
| | - Christopher A. Klinger
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
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Schwalbe D, Sodemann M, Iachina M, Nørgård BM, Chodkiewicz NH, Ammentorp J. Causes of Patient Nonattendance at Medical Appointments: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46227. [PMID: 37723870 PMCID: PMC10656653 DOI: 10.2196/46227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/29/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Approximately one-third of patient appointments in Danish health care result in failures, leading to patient risk and sizable resource waste. Existing interventions to alleviate no-shows often target the patients. The underlying reason behind these interventions is a view that attendance or nonattendance is solely the patient's problem. However, these interventions often prove to be ineffective and can perpetuate social biases and health inequalities, leaving behind patients who are more vulnerable or disadvantaged (in terms of social, economical, and linguistic factors, etc). A more holistic understanding of no-shows is needed to optimize processes, reduce waste, and support patients who are vulnerable. OBJECTIVE This study aims to gain a deep and more comprehensive understanding of the causes, mechanisms, and recurring patterns and elements contributing to nonattendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyzes the relational and organizational processes surrounding no-shows in health care. In addition, the study aims to identify effective communicative strategies and organizational processes that can support the development and implementation of successful interventions. METHODS The study uses mixed quantitative-qualitative methods, encompassing 4 analytical projects focusing on nonattendance patterns, patient knowledge and behavior, the management of hospital appointments, and in situ communication. To address the complexity of no-shows in health care, the study incorporates various data sources. The quantitative data sources include the electronic patient records, Danish central registries, Danish National Patient Registry, and Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using chi-square tests and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semistructured interviews with patients and practitioners, and video recordings of patient consultations. RESULTS This paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. CONCLUSIONS The existing studies of nonattendance in Danish health care are inadequate in addressing relational and organizational factors leading to hospital no-shows. Interventions have had limited effect, highlighting the Danish health care system's failure to accommodate patients who are vulnerable. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing the safety, coherence, and quality of treatment in health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46227.
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Affiliation(s)
- Daria Schwalbe
- Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Centre for Culture and the Mind (DNRF Centre of Excellence), Department of English, German and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sodemann
- The Migrant Health Outpatient Clinic, Odense University Hospital, Odense, Denmark
- Research Unit of Infectious Diseases, Department of Clinical Studies, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nina Høy Chodkiewicz
- Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Jette Ammentorp
- Centre for Patient Communication (CFPK), Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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11
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Camp L, Coffman E, Chinthapatla J, Boey KA, Lux L, Smitherman A, Manning ML, Vizer LM, Haines E, Valle CG. Active Treatment to Survivorship Care: A Mixed-Methods Study Exploring Resource Needs and Preferences of Young Adult Cancer Survivors in Transition. J Adolesc Young Adult Oncol 2023; 12:735-743. [PMID: 36706031 PMCID: PMC10618808 DOI: 10.1089/jayao.2022.0095] [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] [Indexed: 01/28/2023] Open
Abstract
Purpose: The purpose of this study was to identify resource needs and preferences of young adult cancer survivors (YAs) during the transition from active treatment to survivorship care to inform tailored care tools to support YAs during this period. Methods: A mixed methods study following a sequential explanatory approach was conducted among YAs between the ages of 15 and 39. Online surveys were distributed to assess participant information and resource needs, and responses were further explored during virtual focus group and interview discussions. Frequencies and proportions were calculated to identify quantitative resource needs, and a descriptive qualitative approach was used to gather and analyze qualitative data. Results: Thirty-one participants completed the online surveys, and 27 participated in qualitative data collection. The top resource needs identified in the surveys and discussed in focus groups and interviews were (1) fear of recurrence, (2) sleep and fatigue, (3) anxiety, (4) nutrition, (5) physical activity, and (6) finances. Emergent themes identified during transcript analyses included the need for (1) tailored, customizable resources, (2) connection with other survivors, (3) tools to guide conversations about cancer, (4) clarity in what to expect during treatment and survivorship, and (5) consistent and equitable care in YA oncology. Conclusions: Participants identified six important information needs in addition to an overarching need for tailored support and equitable distribution of resources while transitioning into early survivorship. Thus, tailored interventions are needed to enhance the distribution of YA-centered resources, improve equity in YA cancer care, and connect YAs with peer survivors.
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Affiliation(s)
- Lindsey Camp
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Erin Coffman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Juhitha Chinthapatla
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelly Ann Boey
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Lauren Lux
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew Smitherman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pediatrics, Division of Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle L Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa M Vizer
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Haines
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmina G Valle
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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McLoone JK, Sansom-Daly UM, Paglia A, Chia J, Larsen HB, Fern LA, Cohn RJ, Signorelli C. A Scoping Review Exploring Access to Survivorship Care for Childhood, Adolescent, and Young Adult Cancer Survivors: How Can We Optimize Care Pathways? Adolesc Health Med Ther 2023; 14:153-174. [PMID: 37753163 PMCID: PMC10519427 DOI: 10.2147/ahmt.s428215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Childhood, adolescent, and young adult (CAYA) cancer survivors are at risk of developing late effects associated with their cancer and its treatment. Survivors' engagement with recommended follow-up care to minimize these risks is suboptimal, with many barriers commonly reported. This scoping review aims to summarize the barriers to accessing follow-up care, using the dimensions of Levesque's framework for accessing healthcare. We retrieved quantitative studies addressing barriers and facilitators to accessing survivorship care in CAYA survivors from PubMed, EMBASE and CINAHL. Data was categorized into the five healthcare access dimensions outlined in Levesque's framework: i) approachability, ii) acceptability, iii) availability and accommodation, iv) affordability, and v) appropriateness. We identified 27 quantitative studies in our review. Commonly reported barriers to accessing care included a lack of survivor and provider knowledge of cancer survivorship, poor health beliefs, low personal salience to engage in follow-up care, high out-of-pocket costs and survivors living long distances from clinical services. Many studies reported increased barriers to care during the transition from paediatric to adult-oriented healthcare services, including a lack of developmentally appropriate services, lack of appointment reminders, and a poorly defined transition process. Healthcare-related self-efficacy was identified as an important facilitator to accessing follow-up care. The transition from pediatric to adult-oriented healthcare services is a challenging time for childhood, adolescent, and young adult cancer survivors. Optimizing CAYAs' ability to access high-quality survivorship care thus requires careful consideration of the quality and acceptability of services, alongside financial and physical/practical barriers (eg distance from available services, appointment-booking mechanisms). Levesque's model highlighted several areas where evidence is well established (eg financial barriers) or lacking (eg factors associated with engagement in follow-up care) which are useful to understand barriers and facilitators that impact access to survivorship for CAYA cancer survivors, as well as guiding areas for further evaluation.
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Affiliation(s)
- Jordana K McLoone
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Alexia Paglia
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Jessica Chia
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Hanne Bækgaard Larsen
- Department for Pediatric and Adolescent Medicine, The Juliane Marie Center, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark & Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Richard J Cohn
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Christina Signorelli
- Behavioural Sciences Unit, Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW, Australia
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13
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Loecher N, Tran JT, Kosyluk K. Parental Perspectives on Health Care Transition in Adolescent and Young Adult Survivors of Pediatric Cancer. J Adolesc Young Adult Oncol 2023; 12:461-471. [PMID: 36459103 DOI: 10.1089/jayao.2022.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The health care transition (HCT) from pediatric to adult care is pivotal for childhood cancer survivors (CCS) and their parents. However, there is little research examining parental needs during HCT, despite this being a key predictor of successful HCT. The goal of this study was to investigate the needs of parents of CCS during HCT. Using an integrative review of the literature structured around the social-ecological model (SEM) of CCS transition readiness yielded 454 articles, including three hand-searched articles. Six articles were included in the final analysis. Data were extracted into nine factors derived from SEM. Articles were published within the last decade, largely qualitative, and mainly examined parents and CCS together. Parents most frequently mentioned relationships with their practitioner and CCS as contributing to HCT readiness, while abstract factors, such as goal-setting and expectations around HCT, were not mentioned. Our results are limited by the dearth of research on this topic, the homogeneity of samples, and joint presentation of CCS and parent data. Nonetheless, our results indicate that parents do not weigh all aspects of SEM equally, with macrolevel barriers, such as sociodemographic factors being viewed as less salient for HCT readiness. Parents mostly focused on interpersonal factors, such as their relationships with practitioners and CCS, indicating that practitioners should emphasize these in preparing parents for HCT.
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Affiliation(s)
- Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
| | - Jennifer T Tran
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
| | - Kristin Kosyluk
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
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14
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Mullis MD, Fisher CL, Kastrinos AL, Sae-Hau M, Weiss ES, Rajotte M, Bylund CL. Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers. J Cancer Surviv 2023:10.1007/s11764-023-01422-0. [PMID: 37420150 PMCID: PMC11024982 DOI: 10.1007/s11764-023-01422-0] [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: 05/05/2023] [Accepted: 06/21/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. METHODS We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. RESULTS Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). CONCLUSIONS Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. IMPLICATIONS FOR CANCER SURVIVORS Tailored supportive resources are needed for caregivers throughout survivorship transitions.
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Affiliation(s)
- M Devyn Mullis
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Carla L Fisher
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | | | | | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
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15
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Hamilton SN, Howard F, Afghari N, Mahdavi S, Martinez IS, Goddard K. The impact of survivorship care plans on adolescent and young adult head and neck cancer survivors and their primary care providers. Support Care Cancer 2023; 31:448. [PMID: 37418030 DOI: 10.1007/s00520-023-07860-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE A cross sectional study of adolescent and young adult (AYA) head and neck (H&N) cancer survivors was performed to assess late effects. Survivorship care plans (SCPs) were generated and evaluated by participants and their primary care providers (PCPs). METHODS AYA H&N survivors who had been discharged over 5 years prior from our institution were assessed in recall consultation by a radiation oncologist. Late effects were assessed and individualized SCPS were created for each participant. Participants completed a survey evaluating the SCP. PCPs were surveyed before the consultation and after evaluating the SCP. RESULTS 31/36 participants (86%) completed the SCP evaluation. The SCP was considered to be a positive experience for 93% of participants. Most of the AYA participants indicated that the information provided in the SCP helped them understand the need for follow-up to assess late effects (90%). The pre-consultation PCP survey response rate was 13/27 (48%) and only 34% were comfortable in providing survivorship care for AYA H&N cancer patients. The PCP response rate to the survey that accompanied the SCP was 15/27 (55%) and the majority (93%) reported that the SCP would be helpful to care for other AYA and non-AYA cancer survivors in their practice. CONCLUSIONS Our research suggested that AYA head and neck cancer survivors valued the SCPs as did their PCPs. IMPLICATIONS FOR CANCER SURVIVORS The introduction of SCPs is likely to help improve survivorship and transitioning of care from the oncology clinic to PCP in this population.
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Affiliation(s)
- Sarah Nicole Hamilton
- BC Cancer-Vancouver Centre, Vancouver, BC, Canada.
- Univeristy of British Columbia, Vancouver, BC, Canada.
| | | | - Narsis Afghari
- BC Cancer-Vancouver Centre, Vancouver, BC, Canada
- Univeristy of British Columbia, Vancouver, BC, Canada
| | - Sara Mahdavi
- BC Cancer-Vancouver Centre, Vancouver, BC, Canada
| | | | - Karen Goddard
- BC Cancer-Vancouver Centre, Vancouver, BC, Canada
- Univeristy of British Columbia, Vancouver, BC, Canada
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16
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Bingen K, Karst J, Anderson L, Chan S, Jordan A, Morin J, Nichols J, Palou-Torres A, Phelan R, Schmidt D, Yan K, Hoag JA. Evaluation of a transition to survivorship program for pediatric, adolescent, and young adult cancer patients and caregivers. Pediatr Blood Cancer 2023; 70:e30277. [PMID: 36880713 DOI: 10.1002/pbc.30277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Survivorship education and anticipatory guidance represent an unmet need for pediatric, adolescent, and young adult (AYA) cancer survivors and their caregivers when treatment ends. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of a structured transition program, bridging treatment to survivorship, to reduce distress and anxiety and increase perceived preparedness for survivors and caregivers. PROCEDURE Bridge to Next Steps is a two-visit program, within 8 weeks prior to treatment completion and 7 months post treatment, which provides survivorship education, psychosocial screening, and resources. Fifty survivors (age range 1-23 years) and 46 caregivers participated. Participants completed pre- and post-intervention measures: Distress Thermometer and Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety/emotional distress (ages ≥8 years), and perceived preparedness survey (ages ≥14 years). AYA survivors and caregivers completed a post-intervention acceptability survey. RESULTS Most participants (77.8%) completed both visits, and most AYA survivors (57.1%) and caregivers (76.5%) endorsed the program as helpful. Caregivers' distress and anxiety scores decreased from pre to post intervention (p < .01). Survivors' scores remained the same, which were low at baseline. Survivors and caregivers felt more prepared for survivorship from pre to post intervention (p = .02, <.01, respectively). CONCLUSIONS Bridge to Next Steps was feasible and acceptable for most participants. AYA survivors and caregivers felt more prepared for survivorship care after participation. Caregivers reported decreased anxiety and distress from pre to post Bridge, whereas survivors remained at a low level for both. Effective transition programs that better prepare and support pediatric and AYA cancer survivors and families from active treatment to survivorship care can contribute to healthy adjustment.
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Affiliation(s)
- Kristin Bingen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffrey Karst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lynnette Anderson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sherilynn Chan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Anna Jordan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Akasha Palou-Torres
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rachel Phelan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Ke Yan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer A Hoag
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Markwardt HS, Taghavi SE, Williams AP, Olivares MN, McDuffee PR, Hall BC. Tablet Versus Quick Response Code: Difference in Research Participation Rates? JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 8:178-181. [PMCID: PMC9982167 DOI: 10.1007/s41347-023-00311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023]
Abstract
Conducting research with immunocompromised populations, especially within the context of a global pandemic, warrants consideration of alternative research methods and modes of administration to keep participants safe. Digital and internet-based research methods have been utilized to minimize the risk of harm with cancer patients; however, adolescents and young adults with cancer (AYAs) remain an under served and understudied population with high levels of unmet needs. The purpose of the current study was to examine differences in AYA research participation rates based on two digital survey administration methods (tablet versus QR code). AYAs were randomly assigned to complete an online survey using either a tablet or quick response (QR) code, and participation rates in each group were compared. The total participation rate was 22.9%, with 75% of completed surveys from the tablet group and 25% from the QR code group. While the use of a QR code allows for reduced costs for in-clinic recruitment and may be the most sanitary option during COVID-19, eligible patients in the current study showed trends of increased engagement using a sanitized tablet. It is important to consider how psychosocial research and electronic surveys are administered, as the method may impact recruitment and/or information obtained.
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Affiliation(s)
- Haley S. Markwardt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA ,Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Sarah E. Taghavi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA ,Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Addison P. Williams
- Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Matthew N. Olivares
- Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Peyton R. McDuffee
- Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA
| | - Brittany C. Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX USA ,Department of Psychiatry, UT Southwestern Moncrief Cancer Institute, 400 West Magnolia Avenue, Fort Worth, TX 76104 USA ,Fort Worth Adolescent and Young Adult Oncology Coalition, Fort Worth, TX USA
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18
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Goldfarb M, Franco AT. Survivorship, Quality of Life, and Transition to Adult Care for Pediatric and Adolescent Thyroid Cancer Survivors. Thyroid 2022; 32:1471-1476. [PMID: 36193568 DOI: 10.1089/thy.2022.0407] [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] [Indexed: 11/09/2022]
Abstract
The importance of long-term survivorship care to reduce survivor and family anxiety and burden, decrease emergency visits and health care costs, improve knowledge, as well as implement timely surveillance is widely accepted. Most childhood cancer survivors suffer from an increased number of medical and psychosocial comorbidities as they age and are at a higher risk for early mortality, which differs by cancer diagnosis. Childhood thyroid cancer survivors fall within this spectrum. Some have significant complications and/or late effects from treatment, whereas others have no long-term medical late effects, but almost all will require life-long thyroid hormone replacement therapy. Therefore, providing survivorship and transitional care, including a survivorship and/or transitional care plan (SCP/TCP), as well as periodically assessing the needs and quality of life for the patient and their family, should be implemented for our young thyroid cancer survivors.
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Affiliation(s)
- Melanie Goldfarb
- Center for Endocrine Tumors, Providence Saint John's Cancer Institute, Santa Monica, California, USA
| | - Aime T Franco
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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19
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Ichikawa CRDF, Szylit R, Cunha MLDR, Rossato LM, Gesteira ECR. Transition from disease to survival: accounts of adolescents who have experienced cancer. Rev Lat Am Enfermagem 2022; 30:e3846. [PMID: 36449930 PMCID: PMC9699526 DOI: 10.1590/1518-8345.6302.3846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to understand the transition from disease to survival of adolescents who had experienced cancer. METHOD qualitative study, developed with the theoretical framework of symbolic interactionism, conducted with 14 adolescent cancer survivors treated at an outpatient clinic after cancer therapy, in the city of São Paulo. Individual in-depth interviews were performed and recorded, and the data were analyzed and interpreted using the methodological framework of the thematic analysis. RESULTS four themes were identified: going back to school, being able to live like other adolescents, living in the present moment, and seeking a purpose in life. CONCLUSION the transition from disease to cancer survival was full of insecurities, difficulties, and challenges. After the disease, survivors acquire new values and new priorities in life, a reconstruction of the self. They also feel thankful to God and the people who were part of their treatment journey. HIGHLIGHTS (1) Cancer survivors need long-term follow-up.(2) Health professionals are not prepared to support survivors.(3) Adolescents see survival as a new opportunity and feel gratitude.(4) Adolescents seek meaning in their survival.(5) Support planning is important to help in the transition period.
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Affiliation(s)
- Carolliny Rossi de Faria Ichikawa
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Regina Szylit
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| | - Mariana Lucas da Rocha Cunha
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Lisabelle Mariano Rossato
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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20
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von Werthern M, Grigorakis G, Sweet R, Soon K. The Continuity of Cancer: Children and Adolescent's Experiences of Ending Cancer Treatment - A Systematic Review. QUALITATIVE HEALTH RESEARCH 2022; 32:2006-2018. [PMID: 36190313 DOI: 10.1177/10497323221128860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As the research and treatment of childhood cancer steadily progresses, so has the interest in children's needs, not only throughout such treatment but also following completion. Whilst there is increased literature focussing on the long-term psychosocial impact of treatment completion, little is currently known about how children and young people (CYP) experience the more immediate end of their cancer treatment. The current review seeks to examine CYP's experiences of the end of their cancer treatment. Sixteen studies were retrieved using a systematic search strategy across five databases, all of which used qualitative methodology. Thematic synthesis was chosen to analyse the data. Four overarching themes were generated, which encompassed 'the continuity of cancer', 'ambivalence of needs', 'making sense of the cancer experience' and 'sense of self following the ending'. The end of treatment is a time of complexity for CYP, yet it is currently largely overlooked. In order to scaffold these endings for CYP, increased emphasis and thought needs to be placed on the end of treatment and the support that is provided within it.
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Affiliation(s)
| | | | | | - Kristina Soon
- 4919University College London, London, UK
- 4956Great Ormond Street Hospital, London, UK
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21
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Aleshchenko E, Swart E, Spix C, Voigt M, Trocchi P, Langer T, Calaminus G, Baust K, Glogner J, Ihle P, Küpper-Nybelen J, Lüpkes C, Kloppe T, Horenkamp-Sonntag D, Meier I, Marschall U, Dröge P, Klein M, Weiss A, Apfelbacher C. Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence (VersKiK): study protocol of a large scale multi-methods non-interventional study. BMC Health Serv Res 2022; 22:1176. [PMID: 36127717 PMCID: PMC9487026 DOI: 10.1186/s12913-022-08549-3] [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: 07/14/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been shown previously that a relevant proportion of childhood cancer survivors suffers from late effects, which are often directly related to the cancer itself or its therapy, resulting in particular follow-up needs, additionally burdening healthcare systems. Being diagnosed with cancer at a vulnerable stage of development, this group of cancer survivors is at comparatively higher risk of relapse or subsequent cancer. Although national and international follow-up guidelines based on treatment modalities have been developed, their implementation seems to leave room for improvement. Additionally, they lack a sufficient consideration of the survivors' psychosocial needs, affecting their adherence to them. The aim of the VersKiK study is to provide representative information on late effects in childhood and adolescence cancer survivors in Germany. The main research objectives are: (1) to describe the state of follow-up care among survivors after a cancer diagnosis in childhood or adolescence; (2) to quantify the occurrence of late effects among this group of survivors; (3) to examine the adherence to selected audiological and cardiological follow-up guidelines and to identify factors affecting it; (4) to explore actual follow-up needs of paediatric cancer survivors; (5) to review selected follow-up guidelines with the aim to improve and expand them. METHODS VersKiK is designed as a mixed-methods non-interventional study. We will use claims data from statutory health insurance companies in combination with individually linked population-based registry data from the German Childhood Cancer Registry (GCCR). This data base will permit us to quantify diagnoses and procedures in comparison to the general population as well as the adherence to existing follow-up guidelines. Additional information will be obtained through interviews with childhood and adolescence cancer survivors and their informal caregivers, as well as in focus groups with healthcare professionals. DISCUSSION The present study aims to research the actual needs of individuals after cancer diagnosis and treatment in childhood or adolescence - physical, psychological and organisational - in order to improve existing follow-up guidelines. These improvements might further positively affect not only actual care provided to paediatric cancer survivors, but also benefit healthcare systems in general while decreasing consequent medical visits in this group of patients. TRIAL REGISTRATION Registered at German Clinical Trial Register (ID: DRKS00025960 and DRKS00026092).
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Affiliation(s)
- E Aleshchenko
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany.
| | - E Swart
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany
| | - C Spix
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - M Voigt
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - P Trocchi
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany
| | - T Langer
- University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - K Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - J Glogner
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Ihle
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - J Küpper-Nybelen
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Cologne, Köln, Germany
| | - C Lüpkes
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | - T Kloppe
- OFFIS-Institute for Information Technology, Oldenburg, Germany
| | | | - I Meier
- Techniker Krankenkasse (TK), Hamburg, Germany
| | | | - P Dröge
- AOK Research Institute (WIdO), Berlin, Germany
| | - M Klein
- DAK-Gesundheit, Hamburg, Germany
| | - A Weiss
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Bavarian Care and Nursing Authority, Amberg, Germany
| | - C Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto Von Guericke Univiersity, Magdeburg, Germany
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22
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Ellison JL, Brown RE, Ameringer S. Parents' experiences with health care transition of their adolescents and young adults with medically complex conditions: A scoping review. J Pediatr Nurs 2022; 66:70-78. [PMID: 35653900 DOI: 10.1016/j.pedn.2022.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Health care transition (HCT) has become increasingly important as adolescents and young adults (AYAs) with complex medical conditions now live well into adulthood but little attention has been given to parents of AYAs preparing for HCT. OBJECTIVE This scoping review aimed to identify and synthesize information on parental facilitators and barriers to health care transition readiness. ELIGIBILITY CRITERIA English-language, peer-reviewed original studies focused on the parents' experience of HCT were included. Studies were excluded if AYAs were not anticipated to be independent or if AYAs had only mental health disorders. CHARTING METHODS Parent-reported facilitators and barriers were identified in each study and then categorized to identify common themes. RESULTS Themes related to parental facilitators included evidence of coordination between pediatric and adult levels of care, healthcare provider guidance for HCT, and parental awareness and acceptance of natural seasons of life. Themes related to parental barriers included relationship loss, loss of parental role, lack of knowledge and/or skills, and concerns related to the health care system in general. CONCLUSION Common facilitators and barriers were found across studies, regardless of medical diagnosis. Relationships and role change figure prominently in parents' perceptions of the HCT experience and their readiness for their AYA children to transition. These findings suggest potential areas for future research inquiry as well as potential nursing interventions designed to aid parents through HCT.
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Affiliation(s)
| | - Roy E Brown
- Health Sciences Library, Virginia Commonwealth University, USA
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23
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Arpaci T, Altay N, Yozgat AK, Yaralı HN, Özbek NY. 'Trying to catch up with life': The expectations and views of adolescent survivors of childhood acute lymphoblastic leukaemia about long-term follow-up care: A qualitative research. Eur J Cancer Care (Engl) 2022; 31:e13667. [PMID: 35866542 DOI: 10.1111/ecc.13667] [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: 04/05/2022] [Revised: 06/16/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to explore adolescent survivors' views and expectations about long-term follow-up care. METHODS Semi-structured, in-depth interviews were conducted with 16 adolescent survivors of childhood acute lymphoblastic leukaemia. Survivors who had completed treatment at least 2 years ago were involved in the study. Interviews were audio-recorded and transcribed verbatim. An inductive thematic approach was used to analyse the data. RESULTS Four main themes and sub-themes were identified from the analysis as follows: information needs with three sub-themes 'long-term follow-up, healthy life and social life', support needs with three sub-themes 'psychosocial (peer relations etc.), school related and social-emotional (fear of relapse, body image, self-esteem, etc.)', perceived benefits with two sub-themes 'social-emotional and related to long-term follow-up' and perceived barriers 'medical-hospital related and social life'. CONCLUSIONS Adolescent survivors mainly need support in terms of psychosocial aspects: self-esteem-body image, school, peer relations and social activities during follow-up. Identified barriers related to follow-up were school absence and not able to participate social activities. Adolescents specify health promotion approaches as benefits aspects of follow-up. The findings of this study will guide nurses in the long-term follow-up care of adolescent survivors of acute lymphoblastic leukaemia and provide an opportunity to plan individualised follow-up care.
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Affiliation(s)
- Tuba Arpaci
- Department of Nursing, Faculty of Health Sciences, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Naime Altay
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Ayça Koca Yozgat
- Pediatric Hematology and Oncology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Hüsniye Neşe Yaralı
- Pediatric Hematology and Oncology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Pediatric Hematology and Oncology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
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24
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Larsen EH, Mellblom AV, Ruud E, Wahl AK, Lie HC. Prepared for survivorship? Multidisciplinary healthcare professionals' experiences with adolescents’ transition off cancer treatment: A focus group study. Eur J Oncol Nurs 2022; 58:102150. [DOI: 10.1016/j.ejon.2022.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/26/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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25
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McGrady ME, Mara CA, Beal SJ, Chan SF, Sorge CE, Pai ALH. Development and Preliminary Validation of a Multidimensional Psychosocial Assessment Strategy for Young Adults With Cancer. J Pediatr Psychol 2022; 47:952-963. [PMID: 35380687 DOI: 10.1093/jpepsy/jsac032] [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: 11/09/2021] [Revised: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Regular psychosocial assessment is a best-practice guideline for young adult oncology care, but multipurpose, multidimensional, developmentally appropriate patient-reported outcome measurement strategies for young adults with cancer are lacking. This study reported on the development and preliminary validation of the Young Adult Psychosocial Assessment Strategy (YA-PAS), a tool designed to meet this clinical need. METHODS The YA-PAS was developed based on the literature and clinician feedback. 20 young adults with cancer participated in cognitive interviews to provide feedback on complexity, readability, and applicability to inform measure refinement. Following refinements, 100 young adults with a history of cancer participated in an observational study including a preliminary evaluation of YA-PAS factor structure, internal consistency, test-retest reliability, construct and criterion validity, feasibility, and acceptability. RESULTS Cognitive interviews and psychometric evaluation informed modifications and resulted in a measure with 9 domains (anxiety, depression, cognitive functioning, post-traumatic stress, family stressors, support, social isolation, self-efficacy for symptom management, and self-efficacy for medication management) and nonscoring items assessing substance use, life stressors, resources, educational/vocational status, and relationship status. 8 of 9 domains demonstrated acceptable internal consistency (Cronbach's α ≥ 0.70), substantial (r = 0.61-0.80) or almost perfect (r > 0.80) test-retest reliability, and evidence of domain and cut-point validity. 89% of participants were able to complete the YA-PAS within 20 min and 87% were satisfied with the measure. CONCLUSIONS The YA-PAS demonstrated promising psychometric properties, feasibility, and acceptability. Clinical implications and research recommendations are discussed.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Constance A Mara
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Sarah J Beal
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Sherilynn F Chan
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Caryn E Sorge
- Department of Pediatrics, Division of Hematology Oncology, University of Kentucky, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine and Clinical Psychology; Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
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26
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Murphy-Banks R, Kumar AJ, Lin M, Savidge N, Livne E, Parsons SK. Hodgkin lymphoma survivor perspectives on their engagement in treatment decision-making and discussion of late effects. Support Care Cancer 2022; 30:1399-1405. [PMID: 34524526 PMCID: PMC10642770 DOI: 10.1007/s00520-021-06538-6] [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: 05/19/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hodgkin lymphoma has a bimodal age distribution with the first peak occurring within young adulthood and the second, among older adults. Although current therapy provides excellent disease control, survivors are at risk of developing treatment-related late effects (LEs). We sought to understand how survivors in active survivorship care perceived their role in treatment decision-making and when they acquired an understanding of LEs. METHODS Semi-structured interviews were conducted until saturation was reached. Themes were identified through direct content analysis and consensus coding by a multidisciplinary team of coders, including hematology/oncology providers, patient navigators, and survivor stakeholders. RESULTS Seventeen interviews were conducted. Role in initial treatment decision-making fluctuated between passive and active engagement with providers identified as being crucial to this process. Half of interviewees (53%) expressed unmet information needs. Survivors reported having learned about LEs at multiple time points, spanning from before treatment commenced through when a LE was diagnosed. The majority (71%) expressed a desire to have learned about LEs before initial treatment ended. The impact of cancer and fertility discussions were also disclosed. DISCUSSION Participants highlighted the importance of discussions on LEs early in the care continuum. These preliminary data will be incorporated in a planned treatment decision-making tool that incorporates information on potential LEs. IMPLICATIONS FOR CANCER SURVIVORS Patient-centered communication approaches should be embraced to assist in treatment decision-making, while considering long-term health consequences. Survivors must be educated on their risk of LEs and encouraged to disclose their perspectives and preferences with their providers to optimize outcomes.
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Affiliation(s)
- Rachel Murphy-Banks
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Reid R. Sacco Adolescent & Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA
| | - Anita J Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Reid R. Sacco Adolescent & Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Mingqian Lin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Nicole Savidge
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Emma Livne
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., #345, Boston, MA, 02111, USA.
- Reid R. Sacco Adolescent & Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA.
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA.
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27
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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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28
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Ichikawa CRDF, Szylit R, Cunha MLDR, Rossato LM, Gesteira ECR. A transição da doença para a sobrevivência: relatos de adolescentes que vivenciaram o câncer. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6302.3847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Resumo Objetivo: conhecer a transição da doença para a sobrevivência de adolescentes que vivenciaram o câncer. Método: estudo de abordagem qualitativa, desenvolvido por meio do referencial teórico Interacionismo Simbólico, realizado com 14 adolescentes sobreviventes de câncer atendidos em um ambulatório de pacientes fora de terapia na cidade de São Paulo (SP). Foram realizadas e gravadas entrevistas individuais e em profundidade e os dados foram analisados e interpretados pelo referencial metodológico da análise temática. Resultados: quatro temas foram identificados: voltando para a escola; podendo viver como outros adolescentes; vivendo o agora e buscando um propósito na vida. Conclusão: a transição da doença para a sobrevivência do câncer se revelou cheia de inseguranças, dificuldades e desafios. Após a doença, os sobreviventes adquirem novos valores e novas prioridades de vida; uma reconstrução do self; além do sentimento de gratidão a Deus e às pessoas que participaram da trajetória percorrida durante o tratamento.
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29
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Ichikawa CRDF, Szylit R, Cunha MLDR, Rossato LM, Gesteira ECR. La transición de la enfermedad a la supervivencia: testimonios de adolescentes que han sufrido cáncer. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6302.3845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Resumen Objetivo: conocer la transición entre la enfermedad y la supervivencia de adolescentes que han sufrido cáncer. Método: estudio con enfoque cualitativo, desarrollado a través del referencial teórico del Interaccionismo Simbólico, realizado con 14 adolescentes supervivientes de cáncer atendidos en un ambulatorio, sin terapia, de la ciudad de São Paulo (SP). Se realizaron y grabaron entrevistas en profundidad individuales y los datos fueron analizados e interpretados utilizando el marco metodológico de análisis temático. Resultados: se identificaron cuatro temas: regreso al colegio; poder vivir como otros adolescentes; viviendo el presente y buscando un propósito en la vida. Conclusión: la transición entre la enfermedad y la supervivencia del cáncer se mostró llena de inseguridades, dificultades y desafíos. Después que termina la fase de la enfermedad, los supervivientes adquieren nuevos valores y prioridades en la vida; una reconstrucción del Self; además del sentimiento de gratitud hacia Dios y las personas que participaron del camino recorrido durante el tratamiento.
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30
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Psihogios AM, King-Dowling S, O'Hagan B, Darabos K, Maurer L, Young J, Fleisher L, Barakat LP, Szalda D, Hill-Kayser CE, Schwartz LA. Contextual Predictors of Engagement in a Tailored mHealth Intervention for Adolescent and Young Adult Cancer Survivors. Ann Behav Med 2021; 55:1220-1230. [PMID: 33674863 DOI: 10.1093/abm/kaab008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite the promise of mobile health (mHealth), engagement is often too low for durable health behavior change, and little is known regarding why certain individuals abandon mHealth tools. PURPOSE Guided by a mHealth engagement framework, we evaluated contextual predictors of objective engagement with an app for adolescents and young adults (AYA) who survived cancer. METHODS One hundred and ten AYA survivors (M age = 20.5, 43% female, 30% racial/ethnic minority) were randomized to receive a disease self-management app that delivered 1-2 tailored messages/day for 16 weeks, and contained a survivorship care plan (SCP). Demographic, disease, psychosocial, and setting characteristics were examined as predictors of three objective engagement outcomes: (a) % of active app days, (b) % of messages read, and (c) viewed SCP in the app versus not. A subsample (n = 10) completed qualitative interviews to further assess engagement barriers. RESULTS Self-reported uninterrupted app access (β = -0.56, p < .001), iPhone (vs. Android) ownership (β = 0.30, p < .001), and receiving the intervention in the summer (β = -0.20, p = .01) predicted more active days. Lower depressed mood (β = -0.30, p = .047) and uninterrupted app access (β = -0.50, p < .001) predicted more messages read. Qualitatively, technical glitches and competing priorities were described as engagement barriers, whereas certain types of messages (e.g., health goal messages) were perceived as engaging. Among participants who had uninterrupted app access (n = 76), higher baseline motivation to change, better health perceptions, using the app during the summer, and iPhone ownership predicted higher engagement. CONCLUSIONS Findings demonstrate the importance of comprehensively assessing and planning for multi-level ecological determinants of mHealth engagement in future trials. CLINICALTRIALS.GOV IDENTIFIER NCT03363711.
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Affiliation(s)
- Alexandra M Psihogios
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sara King-Dowling
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bridget O'Hagan
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katie Darabos
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jordyn Young
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dava Szalda
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christine E Hill-Kayser
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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31
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Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review. Eur J Oncol Nurs 2021; 54:102040. [PMID: 34571444 DOI: 10.1016/j.ejon.2021.102040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period. METHODS We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information. RESULTS Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care. CONCLUSIONS Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.
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32
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Sadak KT, Gemeda M, Grafelman MC, Aremu TO, Neglia JP, Freyer DR, Harwood E, Mikal J. Identifying metrics of success for transitional care practices in childhood cancer survivorship: A qualitative interview study of parents. Cancer Med 2021; 10:6239-6248. [PMID: 34355520 PMCID: PMC8446395 DOI: 10.1002/cam4.4164] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Survivor‐focused care for adolescent and young adult (AYA) childhood cancer survivors (CCS) often involves their parents. Recognizing the importance of parents in the ongoing care of CCS, our study sought to identify key aspects of a successful transition for CCS from pediatric‐ to adult‐centered care from the parent perspective. Methods We conducted qualitative interviews with 26 parents of CCS who were receiving care in the long‐term follow‐up (LTFU) clinic at a single institution. We used a semi‐structured interview protocol with the parents and conducted a thematic content analysis. Results Using a constant comparison approach, data revealed three primary themes regarding parents’ perspectives toward ensuring a seamless transition from pediatric‐ to adult‐centered follow‐up care: (1) the transition needs to include seamless communication between all involved parties, (2) survivors need to demonstrate sufficient health care self‐efficacy in order to achieve a successful transition, and (3) the survivor‐focused care should include support for survivors’ overall well‐being, including financial and health insurance literacy. Conclusions For parents of AYA CCS, the optimal pediatric to adult care transition model should include mechanisms that facilitate communication between parents, CCS, and survivor‐focused providers while also supporting self‐efficacy and financial literacy as it relates to health insurance.
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Affiliation(s)
- Karim Thomas Sadak
- University of Minnesota Masonic Cancer Center, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Milki Gemeda
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Taiwo O Aremu
- University of Minnesota Masonic Cancer Center, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Norris Comprehensive Cancer Center, Los Angeles, California, USA.,Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eileen Harwood
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jude Mikal
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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33
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Darabos K, Barakat LP, Schapira M, Hill-Kayser C, Schwartz LA. Association of Demographic and Cancer-Specific Factors on Health Behavior Recommendations Specific to Cancer Prevention and Control Among Adolescent and Young Adult Survivors of Childhood Cancer. J Adolesc Young Adult Oncol 2020; 10:619-628. [PMID: 33211609 DOI: 10.1089/jayao.2020.0130] [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: 10/22/2022] Open
Abstract
Purpose: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for long-term health problems that are exacerbated by not meeting health behavior recommendations (e.g., exercise). To identify AYA at risk for not meeting health behavior recommendations, we explored demographic (e.g., age) and cancer-specific (e.g., intensity of treatment) factors associated with not meeting specific health behavior recommendations that have implications for cancer prevention and control. Methods: Regression (linear/binary) was used to examine demographic and cancer-specific associates regarding fruit/vegetable intake, binge drinking, sleep duration, sunscreen use, tobacco use, and physical activity among 307 AYA (Mage = 20.33, range = 15-34) across three combined studies, treated at a pediatric cancer center. Health behavior measures were adapted from The Health Behaviors Survey and the Youth Risk Behavior Surveillance System questionnaire. Results: AYA in general did not meet health behavior recommendations. Compared with AYA with public insurance, AYA with private insurance (β = -0.19, p < 0.01) were more likely to meet multiple health behavior recommendations. AYA at greatest risk for not meeting specific health behaviors were more likely to be diagnosed in middle childhood (11.35years) compared with early childhood (8.38years), be closer to diagnosis (8.77years vs. 11.76years) and closer to treatment completion (6.97years vs. 9.91years), and have a solid tumor (32.7%) compared with a brain tumor (10.6%). Conclusion: Not meeting health behavior recommendations is common among AYA survivors of childhood cancer. Early education in the context of survivorship care is critical to provide teachable moments to AYA; such interventions might impact future long-term health and reduce risk for secondary cancers.
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Affiliation(s)
- Katie Darabos
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lamia P Barakat
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn Schapira
- Department of Medicine, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Hill-Kayser
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sadak KT, Gemeda MT, Grafelman M, Neglia JP, Freyer DR, Harwood E, Mikal J. Identifying metrics of success for transitional care practices in childhood cancer survivorship: a qualitative interview study of survivors. BMC Cancer 2020; 20:898. [PMID: 32957976 PMCID: PMC7507711 DOI: 10.1186/s12885-020-07360-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adolescent and young adult (AYA) childhood cancer survivors (CCS) should be empowered to continue their survivor-focused care as they transition into adult medicine. However, the majority of AYA-aged survivors become lost to follow up around the age of typical transition to adulthood. The purpose of this study was to identify, from the patient's perspective, key factors that facilitate successful transitions to adult-centered survivorship care. METHODS A qualitative study was conducted with AYA CCS (n = 29) from the survivorship clinic of a single institution as key informants. Data were collected through a series of structured phone interviews and subjected to thematic content analysis. RESULTS Four major themes with multiple subthemes were identified: (1) transition practices need to be flexible and individually tailored; (2) effective communication is critical to a successful transition; (3) continuity in providers is needed during the transition; and (4) comprehensive care means care that also addresses psycho-social well-being. CONCLUSIONS From the perspective of AYA CCS, the ideal model of transitional survivorship care could include a patient navigator who promotes provider flexibility, consistent communication, and pro-active comprehensive care that encompasses both medical and psycho-social well-being. Models of care for CCS should be built to provide, or seamlessly facilitate, continuous survivor-focused care across the age continuum. A longitudinal relationship with a survivor-focused provider can help promote the values that CCS' report as important in transitioning care from pediatric- to adult-centered care.
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Affiliation(s)
- Karim Thomas Sadak
- University of Minnesota Masonic Children's Hospital, University of Minnesota Masonic Cancer Center, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA. .,University of Minnesota Medical School, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA.
| | - Milki T Gemeda
- University of Minnesota, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA
| | - Michelle Grafelman
- University of Minnesota Medical School, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA
| | - Joseph P Neglia
- University of Minnesota Masonic Children's Hospital, University of Minnesota Masonic Cancer Center, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA.,University of Minnesota Medical School, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center; California, 4650 Sunset Blvd. MS #54, Los Angeles, CA, 90027, USA.,Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern, California 4650 Sunset Blvd. MS #54, Los Angeles, CA, 90027, USA
| | - Eileen Harwood
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, 420 Delaware St. SE - Mayo MMC 484, Minneapolis, MN, 55455, USA
| | - Jude Mikal
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delware St. SE, MMC729, Minneapolis, MN, 55455, USA
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Andrés‐Jensen L, Larsen HB, Johansen C, Frandsen TL, Schmiegelow K, Wahlberg A. Everyday life challenges among adolescent and young adult survivors of childhood acute lymphoblastic leukemia: An in‐depth qualitative study. Psychooncology 2020; 29:1630-1637. [DOI: 10.1002/pon.5480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Liv Andrés‐Jensen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Copenhagen Denmark
| | - Hanne Baekgaard Larsen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Copenhagen Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Christoffer Johansen
- Late Effects Research Unit CASTLE, Finsen Center Copenhagen University Hospital Copenhagen Denmark
- Survivorship Research Unit Danish Cancer Society Center Copenhagen Denmark
| | - Thomas Leth Frandsen
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Copenhagen Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Copenhagen Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Ayo Wahlberg
- Department of Anthropology University of Copenhagen Copenhagen Denmark
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Darabos K, Ford JS. "Basically, You Had Cancer and Now You Don't": Exploring the Meaning of Being a "Cancer Survivor" Among Adolescents and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2020; 9:534-539. [PMID: 32239966 DOI: 10.1089/jayao.2019.0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Survivorship experiences among adolescent and young adults (AYA) with cancer are unique and may involve a process of identity construction. This qualitative study explored AYA survivors' felt experience of being a cancer survivor focusing on the meaning of survivorship and whether identifying as a "cancer survivor" is consistent with their self-concept. Methods: Twenty-six individual semistructured interviews were conducted with AYA (M = 19.6 years; range: 16-24) with a history of cancer diagnosed between the ages of 14 and 18 (M = 15.6 years). Relevant themes in the literature and through clinical practice guided the development and use of the semistructured interview guides. Results: Thematic content analysis was used to identify cancer-related identities. Three identities emerged: Embracing: acceptance and identification with being a "cancer survivor," cancer is a significant part of their life, Part of the Past: identifies as a "cancer survivor," but does not let cancer define their life or see cancer as a nonissue, and Not Part of my Identity: does not identify with the term "cancer survivor," cancer seemed like a small event. Conclusion: AYA construct different meanings to the words "cancer survivor." These different meanings might reflect a process of identity construction, for some, the characteristics of cancer seemed integrated into one's self-concept, for others, the thought of being a "cancer survivor" rarely entered how they defined themselves. These findings shed light into how AYA reconcile integrating a cancer experience into their self-concept and emphasize the importance of not one-size-fits-all approach to understanding AYA internalization of being a cancer survivor.
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Affiliation(s)
- Katie Darabos
- Department of Behavioral Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, New York, USA
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Stoneham SJ. AYA survivorship: The next challenge. Cancer 2020; 126:2116-2119. [DOI: 10.1002/cncr.32774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Sara J. Stoneham
- Department of Pediatric Oncology University College Hospital London London United Kingdom
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Schwartz CL. Creating a bridge for transition: From pediatric cancer survival to life-long, risk-based health care of the adult cancer survivor. Cancer 2020; 126:473-476. [PMID: 31626326 DOI: 10.1002/cncr.32569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Cindy L Schwartz
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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