Social isolation and connection in adolescents with cancer and survivors of childhood cancer: A systematic review

"They Did Not Understand": Exploring Adult Survivors of Childhood Cancer's Memories of Their Experiences With Peers

Background: Peer relationships are impacted by the diagnosis of childhood cancer. Children with cancer can feel isolation, such as bullying and lack of engagement, from their peers. As the rates of survival increase, one way to further learn about the experiences of childhood cancer is to reflect on the memories of adult survivors. This study examines adult survivors of childhood cancer's memories of their experiences with peers during their cancer. Method: Twenty-seven adult survivors (15 male, 12 female) of childhood cancer were recruited from Amazon Mechanical Turk, a crowdsourcing marketplace for survey distribution, and surveyed about their experiences with peers during childhood cancer. Using inductive thematic analysis, open-ended survey questions were analyzed. Results: Five main themes emerged, including age, perceptions of cancer, acts of kindness, peer responses, and limited peer engagement. Participants' memories included peers' lack of understanding about their diagnosis, prognosis, and treatment, positive and negative responses to their cancer diagnosis, acts of services and gifts from peers, and feelings of isolation during the cancer experience. Discussion: In the current study, adult survivors of childhood cancer had specific memories about how cancer impacted peer relationships. Such findings contribute to the evidence that children with cancer could benefit from psychosocial interventions, including education to peers about the diagnosis and the impact of diagnosis on peer relationships, peer engagement activities, and peer support groups.

Social isolation, depression, and anxiety among young adult cancer survivors: The mediating role of social connectedness

BACKGROUND

Social isolation and social connectedness are health determinants and aspects of social well-being with strong associations with psychological distress. This study evaluated relationships among social isolation, social connectedness, and psychological distress (i.e., depression, anxiety) over 1 year in young adult (YA) cancer survivors 18-39 years old.

METHODS

Participants were YAs in a large cohort study that completed questionnaires every 2 months for 1 year. Social isolation, aspects of social connectedness (i.e., companionship, emotional support, instrumental support, and informational support), depression, and anxiety were assessed with Patient-Reported Outcomes Measurement Information System short form measures. Mixed-effect models were used to evaluate changes over time. Confirmatory factor analysis and multilevel structural equation modeling were used to define social connectedness as a latent construct and determine whether relationships between social isolation and psychological distress were mediated by social connectedness.

RESULTS

Participants (N = 304) were mean (M) = 33.5 years old (SD = 4.7) and M = 4.5 years (SD = 3.5) post-initial cancer diagnosis. Most participants were female (67.4%) and non-Hispanic White (68.4%). Average scores for social well-being and psychological distress were within normative ranges and did not change (p values >.05). However, large proportions of participants reported at least mild social isolation (27%-30%), depressive symptoms (36%-37%), and symptoms of anxiety (49%-51%) at each time point. Across participants, more social isolation was related to less social connectedness (p values <.001), more depressive symptoms (p < .001), and more symptoms of anxiety (p < .001). Social connectedness mediated the relationship between social isolation and depression (p = .004), but not anxiety (p > .05).

CONCLUSIONS

Social isolation and connectedness could be intervention targets for reducing depression among YA cancer survivors.

Examining the emotional healing process through bibliotherapy in adolescents with cancer: A qualitative descriptive study

PURPOSE

This study aimed to investigate how interactive bibliotherapy impacted the emotional healing process of adolescents with cancer, drawing upon the three-stage emotional healing process theory-identification, catharsis, and insight.

METHOD

A qualitative descriptive study was conducted on data from 14 adolescents, aged 10-19 years, diagnosed with or relapsing from leukemia or osteosarcoma within the past two years. Participants received two interactive bibliotherapy sessions using The Rabbit Listened and You Are Special. Data were collected through semistructured interviews and content analyzed.

RESULTS

Analysis identified six themes in The Rabbit Listened and eight in You Are Special. Adolescents primarily engaged in identification, empathizing with protagonists and recalling personal experiences. They underwent catharsis, releasing negative emotions and fostering positivity. Insights emerged on companionship, listening, and others' criticism.

CONCLUSIONS

Our study validates the use of the three-stage emotional healing process in interdisciplinary bibliotherapy for understanding emotional changes in adolescents with cancer. It sheds light on their concerns and coping strategies. Healthcare practitioners can utilize interactive bibliotherapy based on this framework to initiate therapeutic communication with adolescent cancer patients and improve interventions and care.

Experiences of paediatric terminal oncology patients and their parents in palliative care: A qualitative systematic review

PROBLEM

The terminal phase of childhood cancer poses profound physical and mental challenges for children, simultaneously influencing parents and rendering them particularly susceptible to psychosocial issues.

ELIGIBILITY CRITERIA

This review included studies exploring the experiences of either: (1) paediatric terminal oncology patients aged under 18 years, (2) parents with a child facing terminal cancer undergoing palliative care, or (3) parents with a child who had undergone palliative care and died. English language, qualitative journal studies or grey literature of any care settings, geographical locations and publication years were included. Studies exploring the experiences of (1) paediatric terminal oncology not receiving palliative care from qualified healthcare professionals, and (3) non-biological parents or non-parental family members, were excluded.

SAMPLE

A total of 22 studies were included, published between January 2000 and December 2023. Seventy-two children (aged between 5 and 18 years old) and 236 parents (aged between 24 and 57 years old) participated across all studies. Palliative care settings mostly comprised oncology centres, hospitals and homes.

RESULTS

Two themes were identified from the 22 included studies: (1) Navigating rough waters and enduring hardships, and (2) Preparing for end-of-life amidst the looming threat of death.

CONCLUSIONS

This review underscored the importance of integrating palliative childhood cancer care in a holistic, age-specific, family-centred, person-centred and timely manner.

IMPLICATIONS

Paediatric oncology nurses should attend to physical and psychosocial needs of children and parents, fostering familial and social ties while recognising cultural and spiritual needs. Future research could recruit participants of varying ages, genders, and cultures.

Barriers to Care and Perceived Need for Mental Health Services Among Adolescent and Emerging Adult Survivors of Pediatric Brain Tumors

Purpose: Pediatric brain tumor survivors (PBTS) commonly experience mental health challenges, which can be exacerbated during adolescence and emerging adulthood (AEA). We examined survivors and caregivers' perceived need for mental health services and barriers to receiving mental health care. Methods: Families completed surveys to assess perceived need for mental health services, socioemotional impairment, and barriers to mental health services. Survivors were between 13 and 25 years of age and were at least 5 years from diagnosis. Results: Sixty-nine caregiver-PBTS dyads participated, as well as 18 survivors and 20 caregivers who participated individually. Approximately half of survivors were male (n = 57, 52.3%), 85% (n = 93) were White, and their average age was 19.31. Most caregivers (n = 63, 70.8%) and survivors (n = 55, 63.2%) endorsed need for services for the survivors. Adolescents endorsed more barriers related to perceived helpfulness, t(18) = 2.3, p = 0.03, d = 0.54, and effects of services, t(18) = 3.8, p < 0.001, d = 0.88, than their caregivers. Emerging adults, t(34) = 2.4, p = 0.02, d = 0.41, endorsed more content barriers than their caregivers.. Discussion: Both survivors and their caregivers reported obstacles to accessing mental health services such as perceived lack of need, concerns regarding the effectiveness and usefulness of services, and limited knowledge about the content of services. Psychoeducation and psychosocial screening can support families in understanding survivors' need for mental health services.

Factors Influencing Social Isolation among Cancer Patients: A Systematic Review

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.

Public perceptions of families affected by pediatric cancer and educational work in pediatric oncology

BACKGROUND

This study aims to explore how Russian society perceives children with cancer and their families to determine its potential as a tool for solving the social struggles of cancer-affected youth.

METHODS

The study took place between 2019 and 2020 and involved 237 parents of cancer-affected children enrolled for inpatient treatment in 5 pediatric oncology clinics in the North Caucasus Federal District (Russia). The study exploits a specially designed questionnaire survey as its main research method.

RESULTS

About half of the parents did not observe changes in their attitude towards their child following a cancer diagnosis, with women more frequently noting these changes (40% vs. 18%). Public sentiment diverges between poles of sympathy and alienation: 53% acknowledge the expression of sympathy, while 39% perceive a sense of alienation. This study underscores the imperative for adequate support for these families, encompassing both financial and social dimensions.

CONCLUSION

The present findings can be used to design cancer awareness and anti-stigma programs aimed at educating the general population about the early symptoms of cancer, where to receive health consultation services, how to talk with and act around cancer-affected children, and how to support such children and their families.

IMPACT

Despite advances in modern medicine and multiple cases of pediatric cancer being successfully treated, stereotypes about the incurable nature of cancer still exist in many countries. The present findings can serve as a platform for the comparative study of cancer-related issues in other regions and countries. The results of this study can also be used to design cancer awareness and anti-stigma programs aimed at educating the general population about the early symptoms of cancer, where to receive health consultation services, how to talk with and act around cancer-affected children, and how to support such children and their families.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Psychosocial Impact of the COVID-19 Pandemic on Adolescent and Young Adult Cancer Survivors in the United States: An Integrative Review

Adolescent and young adult cancer survivors (AYAs) are uniquely challenged with navigating health care systems during an important developmental phase of life. During the Coronavirus disease 2019 (COVID-19) pandemic, many people experienced social isolation, mental health symptoms, and schooling and employment changes, which may have affected vulnerable AYA cancer survivors. The purpose of this integrative review is to explore the psychosocial impact of the COVID-19 pandemic on AYA cancer survivors in the United States. A literature search was conducted in November 2022 using PubMed, Web of Science, and SCOPUS databases with the following search terms: distress*, depress*, lonel*, anx*, insomnia*, cancer*, neoplasm, COVID-19, coronavirus, young adult, AYA, teen*, and adolescen*. The initial search yielded 468 articles. Inclusion criteria required that studies were conducted in the United States, published in English, with a sample of patients diagnosed with cancer between ages 15 and 39. After review and appraisal of each relevant article, eight were included. Through comparative analysis of eight articles, including qualitative and quantitative studies, three themes emerged: mental health impact, health care impact, and financial impact. Mental health impact included increased anxiety, worsening depression and social isolation, and sleep disturbances. Changes in health care included delays in care, medical cost-coping and benefits of virtual care. Financial difficulties included employment changes and benefits of remote work. The COVID-19 pandemic had an immense impact on the psychosocial health of AYA cancer survivors. It is essential that oncology providers and health care teams consider specific interventions to best serve the psychosocial needs of their AYA patients.

"It just made me feel better": qualitative examination of the implementation of a novel virtual psychosocial support program for adolescents with cancer

PURPOSE

Adolescents with cancer routinely report feelings of isolation and exclusion, including from medical decision-making. To address this problem and support adolescents, we designed and implemented the novel, virtual, weekly Teens4Teens peer support group and patient education program. We examined the views of participating adolescents, program guest speakers, and program moderators as they pertained to the need for the program, its feasibility, acceptability, and perceived impact.

METHODS

We recruited all available adolescents, moderators, and guest speakers who participated in Teens4Teens to take part in audio-recorded, semi-structured interviews. Interviews were transcribed, coded, and analyzed using thematic analysis.

RESULTS

We conducted 21 interviews across participant groups. We identified four broad themes: pathways into the Teen4Teens program, Teens4Teens implementation capacity, perspectives of the positive impact of Teens4Teens, and suggestions to improve Teens4Teens. These themes described a perceived need for adolescent-centered psychosocial programming in pediatric cancer care, provided lessons on how best to build and apply such a program, and highlighted the value of the program for both adolescents' and clinicians' acceptability, feasibility, and perceived utility.

CONCLUSION

Adolescents, guest speakers, and moderators valued Teens4Teens and made suggestions to improve capacity to routinely implement the program. Adolescent-tailored psychosocial programming, such as Teens4Teens, is positioned to be integrated into clinical care with relative ease and may serve to improve the cancer care experience of adolescents and their families. This study has potential to provide researchers and clinicians with valuable information about the content, design, and delivery of virtual peer support programming for adolescents with cancer.

Program evaluation of a wilderness experience for adolescents facing cancer: A time in nature to heal, connect and find strength

OBJECTIVE

Despite advances in cancer treatment and increased survival, adolescents in treatment for cancer often suffer from psychosocial distress, negative mood, and chronic health problems. Wilderness therapy is considered a promising program to address psychosocial issues among adolescents with mental or behavioral health issues. There is little research on whether it may benefit adolescents in cancer treatment.

METHODS

This program evaluation in the form of a pilot study uses qualitative and quantitative measures to describe the feasibility, acceptability, safety, and to explore the impact of a nine-day wilderness program among adolescents aged 13-17 in treatment or who recently finished treatment for a cancer. Quantitative tracking documented recruitment, retention, safety, and participant satisfaction. PROMIS measures assessed mental and social health, positive affect, fatigue, pain interference and intensity over three time-points: pre, post, and three-months after the nine-day wilderness experience. Mean differences were compared over time. Qualitative data collection involved participant observation and open-ended interviews.

RESULTS

Study enrollment goals were met, enrolling eight adolescent participants with 100% participant retention. No serious adverse events were reported and participants described high satisfaction (9.25/10) with the wilderness experience on the final day and at three-months follow-up (9.5/10). Exploratory data analysis showed scores in a favorable direction indicating improved psychosocial outcomes in physical functioning, anxiety, depression, fatigue, and peer relations. From qualitative analysis it is suggested that program participation supported: increased self-confidence and peer connection. The program was evaluated as increasing personal accomplishment, supporting social interaction, having strong staff support, and capitalizing on the natural surroundings.

CONCLUSION

Use of a wilderness program is feasible, acceptable, and safe among this highly vulnerable adolescent cancer population. Participants described greater self-confidence and peer connection which developed as participants experienced physical competency, group leadership, and personal strength. Larger randomized controlled studies are needed to learn whether these programs can improve psychosocial outcomes.

Social isolation and social connectedness among young adult cancer survivors: A systematic review

BACKGROUND

Social isolation and connectedness are social determinants of health that have demonstrated effects on cancer-related outcomes. These constructs have been systematically evaluated among pediatric and older adult cancer populations. In this review, the authors evaluated the prevalence, correlates, and psychosocial implications of social isolation and connectedness among young adult (YA) cancer survivors aged 18-39 years.

METHODS

Peer-reviewed articles published in English before June 2021 were identified from database searches and included articles' reference lists according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included articles described studies that assessed social isolation and/or connectedness among YA cancer survivors.

RESULTS

In total, 5094 unique records were identified; 4143 were excluded after title/abstract screening, and 907 were excluded after full-text review. Forty-four articles were included. Few studies used validated measures or directly assessed social isolation or connectedness. Social isolation was similarly prevalent among YAs and older cancer survivors and noncancer populations. Demographic, clinical, and behavioral risk and protective factors for social isolation were identified. Social isolation was related to worse psychological well-being, whereas social connectedness was often, but not always, related to better psychological well-being.

CONCLUSIONS

This growing literature underscores the relevance of social isolation and connectedness as important health determinants among YA cancer survivors. The identified risk and protective factors can identify YAs who especially may benefit from screening for social isolation. Future studies are needed that directly, reliably, and validly evaluate social isolation and connectedness to inform the development of interventions to decrease isolation and increase connectedness.

Development and psychometric properties of the social adjustment scale for youth cancer survivors in South Korea

Objective

We developed a new scale-the Social Adjustment Scale for Youth Cancer Survivors-and examined its psychometric properties.

Methods

In the scale's development stage, preliminary items were constructed based on the results of a concept analysis of the hybrid model, literature review, and interviews. These items were then reviewed through content validity and cognitive interviews. In the validation stage, 136 survivors were recruited from two children's cancer centers in Seoul, South Korea. An exploratory factor analysis was performed to identify a set of constructs, and validity and reliability were tested.

Results

Starting with 70 items constructed through literature review and interviews with youth survivors, the final scale comprised 32 items. The exploratory factor analysis identified four domains-namely, role achievement in one's present position, harmony in relationships, disclosure and acceptance of cancer history, and preparation and expectation for future roles. Correlations with quality of life indicated good convergent validity (r ​= ​0.82, P ​< ​0.001). The Cronbach's α of the overall scale was 0.95, indicating excellent internal consistency; and the intraclass correlation coefficient was 0.94 (P ​< ​0.001), suggesting high test-retest reliability.

Conclusions

The Social Adjustment Scale for Youth Cancer Survivors exhibited acceptable psychometric properties in measuring the social adjustment of youth cancer survivors. It can be used to identify youths facing difficulty in adjusting to society after treatment and to investigate the effect of interventions implemented to promote social adjustment among youth cancer survivors. Future research is needed to examine the applicability of the scale in patients across diverse cultural backgrounds and healthcare systems.

Perceptions of children with cancer and their parents regarding illness: A qualitative study

PURPOSE

The current study aims to understand inter-generational differences and similarities in the perception of illness and the available resources employed by children with cancer and their parents.

METHODS

A qualitative descriptive research design was utilized, including face-to-face interviews with 108 parent-child dyads where the children had been diagnosed with cancer, by means of a semi-structured questionnaire. The participants were recruited from two pediatric hematology-oncology wards in two different hospitals in Israel. The data were analyzed using conventional qualitative content analysis. Debriefing and inter-rater reliability methods were utilized.

FINDINGS

Similarities were found between the coping of children and parents with the illness. Children with cancer and their parents can find bright sides and support for coping, such as different perspectives on life, faith, positive thoughts, and family assistance. Most of the differences between the perceptions of children and parents relate to the difficulties encountered. While parents are mainly concerned about the long-term impact, children contend with ordeals involving the here-and-now.

CONCLUSIONS

Parents and children demonstrate a dual process in their challenging journey. Positive and facilitating factors are intertwined with the aggravating aspects, which exist side by side.

PRACTICE IMPLICATIONS

Nursing staff should advise children and their parents to attain and use external and internal sources of support found in this study to help them deal with cancer.

Efficacy of interdisciplinary rehabilitation in child cancer survivors: Impact on physical fitness, fatigue and body composition after 1-year follow-up

OBJECTIVE

Childhood cancer survivors experience reduced physical activity level, participation as well as health-related quality of life. This prospective, pre-/post-intervention and follow-up cohort study aims to determine the efficacy of an interdisciplinary rehabilitation on improving physical fitness, fatigue and body composition.

METHODS

A total of 24 childhood cancer survivors (mean age: 12.15 years ± 3.2; 14 females; 10 males) were recruited 6 months after medical treatment and received a 4-month interdisciplinary intervention. Cardiorespiratory fitness (PredVO_2peak and PredLoad_max ), body composition (dry lean weight) and quality of life (general fatigue) were assessed at baseline, post-intervention and 1-year follow-up. Linear mixed models were used to analyse data.

RESULTS

Linear mixed modelling revealed a significant main effect of time on predicted maximal load (F = 13.189, df = 36.179, p < 0.001), dry lean weight (F = 64.813, df = 37.019, p < 0.001) but also significant improvement of general fatigue score (-9.039 ± 4.300, 95% CI -17.741 to -0.336, p = 0.042), indicating a decline in general fatigue.

CONCLUSION

With emerging evidence that physical activity is safe and feasible, together with increasing numbers of childhood cancer survivors at risk for long-term chronic co-morbidities, this study advocates for better access to interdisciplinary rehabilitation programmes in order to improve their physical condition and their body composition and reduce fatigue.

Seeking virtual support: Digital technology use in adolescent and young adults with advanced cancer

BACKGROUND

A cancer diagnosis, especially advanced cancer, interferes with adolescent/young adult (AYA) peer relationships. AYAs increasingly use digital technologies (i.e., social media, video games) as a social instrument; little is known about the role of digital technologies in the AYA cancer experience. The objective of this analysis was to describe the use and impact of digital technologies among AYAs with advanced cancer.

PROCEDURE

As part of the "Exploring the Concept of a 'Good Death'" study, semi-structured interviews were conducted with 32 English-speaking AYAs (14-25 years) with advanced cancer (relapsed/refractory disease, estimated survival <50%). Interviews were audio recorded, deidentified, and transcribed verbatim. Questions focused on communication and sources of psychosocial support. Directed content analysis was used for codebook creation. Three reviewers completed transcript coding and reconciled discrepancies. Thematic analysis identified hierarchical themes. The present analysis focused on the specific theme of "digital technologies as a support mechanism."

RESULTS

When asked about sources of support, social media and multiplayer online games were most often recognized by AYAs. Three themes emerged regarding the role of digital technologies: distraction, maintaining existing peer support, and connecting with peers with cancer. Two AYAs acknowledged negative consequences of social media.

CONCLUSIONS

AYAs with advanced cancer cite digital technologies as a mechanism for maintaining and seeking peer support. Digital technologies may be leveraged to provide psychosocial support for AYAs with advanced cancer.

The Perceived Impact of COVID-19 on the Mental Health Status of Adolescent and Young Adult Survivors of Childhood Cancer and the Development of a Knowledge Translation Tool to Support Their Information Needs

Background

Adolescent and young adult (AYA; 13 to 39 years) survivors of childhood cancer may be especially vulnerable to physical health and mental health concerns during the pandemic. We investigated the impact of COVID-19 on the mental health status of AYA survivors (Aim 1) and shared tailored, evidence-based health-related information on COVID-19 (Aim 2).

Methods

Between May and June 2020, participants completed a cross-sectional online survey assessing their cancer history, current mental health status, and their COVID-19 information needs.

Results

Ninety-four participants (78 females, 13 males, 2 non-binary) with a mean age of 26.9 years (SD = 6.2) were included in the final sample. Participants reported residing from 10 countries and 94% identified as White. Nearly half of the participants (49%) described their mental health status as worse now than before the pandemic. Thirty-nine participants (41%) that indicated their current mental health status was tied to fears/worries about their past cancer and treatment experienced a higher level of anxiety and PTSS than those who did not report the same. Most participants (77%) had not received any information related to the potential risks of COVID-19 and expressed an interest in receiving this information. In response, an infographic detailing recommended strategies for coping with mental health problems in the pandemic, along with preliminary study findings, was developed.

Discussion

AYA survivors reporting their mental health status was linked to their past cancer experienced poorer mental health. There is a value to educating survivors on their potential health risks, but accounting for their perceived mental health vulnerabilities should be considered when disseminating knowledge. The use of an infographic is a unique contribution towards the development of innovative and personalized means of sharing health education to this vulnerable yet resilient group. This research on the mental health status of AYA survivors very early in the pandemic informs continued initiatives investigating the rapidly changing nature of how COVID-19 may impact AYA survivors today and in the future.

Impacts of the psychological stress response on aggression in adolescents during the COVID-19 epidemic in China

The sudden outbreak of COVID-19 has exerted a tremendous impact on the psyche of people around the world, especially adolescents. In order to provide a valuable theoretical basis for effective measures to prevent psychological problems in adolescents during public health emergencies in the future, this study examined the mediating effect of coping style (CS, including positive coping style (PCS) and negative coping style (NCS)) and the moderating effect of emotional management ability (EMA) on the relationship between the psychological stress response (PSR) and aggression (AGG) in adolescents during the COVID-19 epidemic in China. The Buss–Warren Aggression Questionnaire, Simplified Coping Style Questionnaire, and Emotion Management Questionnaire were employed to investigate the mental health of Chinese adolescents from April 10–20 (Time point 1, T1) and May 20–30 (Time point 2, T2), 2020. A total of 1,931 adolescents (aged 10–25 years, M = 19.18 years, 51.4% male) were examined at T1 and 334 adolescents (aged 11–25 years, M = 19.97 years, 48.7% male) were reinvestigated at T2. Overall, 17.6% of the participants at T1 and 16.8% at T2 reported obvious PSR activation. NCS partly mediated the relationship between the PSR and AGG, and the indirect effect was moderated by EMA reported at T2. There were regional differences in the moderated mediation model in low-risk areas at T1. The moderated effects of EMA at T1 and T2 were opposite. Specifically, high EMA resulted in a stronger relationship between NCS and AGG at T1, whereas high EMA resulted in a weaker relationship between NCS and AGG at T2. Psychological reactions resulting from sudden public health events may trigger AGG in younger individuals. However, EMA may have a buffering effect on the onset of AGG. This research expands our understanding of the development of AGG in adolescents during the pandemic.

Psychosocial impact of the War in Ukraine on pediatric cancer patients and their families receiving oncological care outside their country at the onset of hostilities

Psychosocial care of pediatric cancer patients and their families is as critical as the medical and surgical components of their therapies. Strains on family communication and structure and financial need are linked to poorer psychological outcomes for both patients and families. It is critical that children remain as connected as possible to their communities and extended families during therapy. For Ukrainian pediatric cancer patients receiving care outside of their nation's borders on February 24, 2022, the Russian invasion of Ukraine compounded these problems. Based on conversations with patients and parents, we evaluated the psychosocial impact of war on pediatric Ukrainian cancer patients and their families who had left their country before the onset of the conflict to undergo treatment of pediatric malignancies at our medical center. These families shared with us the problems they have experienced after the Russian invasion of Ukraine. Their concerns can be summarized in 4 categories: (1) emotional stress experienced by the patients, families and relatives related to the dangers of war; (2) difficulties in obtaining previous hospital records in Ukraine; (3) medical expenses; and (4) uncertainty regarding the patient's and their family's future and the ability of the children to ever return to their homes. Psychosocial distress relating to the violence of war will hopefully pass in near future, but our pediatric patients and their families will continue to face stressors related to displacement and financial concerns for some time to come.

Visualizing the Invisible-The Needs and Wishes of Childhood Cancer Survivors for Digitally Mediated Emotional Peer Support

This study aims to identify the needs and wishes of childhood cancer long-term survivors for digitally mediated emotional peer support. Survivors of childhood cancer (six men, seven women) aged 19–33, participated in semi-structured interviews (November–December 2020). Age of diagnosis ranged from 1 to 13 years. The interviews lasted between 45 and 85 min. A thematic analysis was used to identify three themes for needs: processing long-term complications of cancer treatment, processing psychosocial health and meeting others who share similar experiences; and another three themes reflecting wishes: digital tools for connecting with people who had had similar experiences, different modes of communication and a safe place with varying degrees of anonymity. The findings emphasized the needs and wishes of childhood cancer survivors to meet others who had had similar experiences using a digital tool that offered a secure place, with options for a variety of communication methods and levels of anonymity. Peer support can serve as an important complement to professional psychosocial support.

Childhood cancer survivorship care during the COVID-19 pandemic: an international report of practice implications and provider concerns

PURPOSE

Long-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers.

METHODS

A COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questionnaire to LTFU service providers in 37 countries across Europe, Asia, North America, Central/South America, and Australia. The questionnaire assessed how care delivery methods changed during the pandemic and respondents' level of worry about the pandemic's impact on LTFU care delivery, their finances, their health, and that of their family and friends.

RESULTS

Among 226 institutions, providers from 178 (79%) responded. Shortly after the initial outbreak, 42% of LTFU clinics closed. Restrictions during the pandemic resulted in fewer in-person consultations and an increased use of telemedicine, telephone, and email consultations. The use of a risk assessment to prioritise the method of LTFU consultation for individual CCS increased from 12 to 47%. While respondents anticipated in-person consultations to remain the primary method for LTFU service delivery, they expected significantly increased use of telemedicine and telephone consultations after the pandemic. On average, respondents reported highest levels of worry about psychosocial well-being of survivors.

CONCLUSIONS

The pandemic necessitated changes in LTFU service delivery, including greater use of virtual LTFU care and risk-stratification to identify CCS that need in-person evaluations.

IMPLICATIONS FOR CANCER SURVIVORS

Increased utilisation of virtual LTFU care and risk stratification is likely to persist post-pandemic.

Adolescent Resilience Profiles (on the Example of Adolescents with Congenital, Acquired Disabilities and Healthy Peers)

The problem of the research is important in the context of psychological assistance and interaction with adolescents with disabilities. The study aimed to carry out a comparative analysis of the resilience profiles of adolescents with congenital (cerebral palsy), acquired disabilities (oncology, rheumatic diseases) and healthy peers. The study involved 51 adolescents with cerebral palsy, 61 with oncological diseases, 51 with rheumatic diseases and 86 conditionally healthy adolescents aged 13 to 18 years old. In total it embraced 249 teenagers (mean age 14.94+1.48), of which 128 were male and 121 were female. There were used the following methods: the “Victimity” questionnaire (M.A. Odintsova, N.P. Radchikova), “Resilience Test” (E.N. Osin, E.I. Rasskazova) and “COPE” questionnaire (E.I. Rasskazova, T.O. Gordeeva, E.N. Osin). The study revealed significant differences in the resilience profiles of adolescents from different groups: healthy teenagers are mainly characterized by unstable and resilient profiles; adolescents with oncology and rheumatic diseases — by all three profiles; adolescents with cerebral palsy — by victim and unstable ones. The female part of the sample, unlike the male part, are characterized by unstable and victim profiles. The most significant differences in groups with different resilience profiles were found in coping strategies related to the dysfunctional coping style. The use of coping strategies: behavioral disengagement, mental disengagement, concentration on emotions and humor leads to a decrease in resilience in the boys of the entire sample. Concentration on emotions, behavioral disengagement, mental disengagement, and infrequent use of active coping are predictors of reduced resilience in girls.

Gendered trajectories of depressive symptoms and social interactions among cancer patients

PURPOSE

This study examines whether and how depressive symptoms and social interactions change before and after cancer diagnosis, and whether this pattern varies by gender.

METHODS

This study used data about 722 middle- and older-aged adults from seven waves (3,963 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. Gender-stratified fixed effects regression models were used to investigate the effect of cancer diagnosis on changes in depressive symptoms and the frequency of social interactions (with friends, relatives, acquaintances, and neighbors) before and after cancer diagnosis.

RESULTS

For both men and women, an increase in depressive symptoms was found in the first and second year after cancer diagnosis, though the increase in the second year was significantly greater for men than women. Only men continued to suffer higher depressive symptoms after the third year and subsequent years. This study also found a decrease in the frequency of social interactions only among men in the second year and subsequent years after cancer diagnosis.

CONCLUSION

Trajectories of psychosocial adjustment to cancer are gendered. The psychosocial consequences of cancer are greater and last longer for men than women.

Social Anxiety Symptoms in Survivors of Childhood and Adolescent Cancer

Purpose: Adolescent and young adult (AYA) cancer survivors may be at risk of developing symptoms of social anxiety disorder (SAD) due to disruptions in social participation and functioning following a cancer diagnosis. This study aimed to explore (1) the proportion of Australian AYA-aged survivors of childhood and adolescent cancer who experience symptoms of SAD, (2) how symptoms of SAD are described by survivors as affecting their daily social functioning. Methods: A mixed-methods cross-sectional design was employed, inviting survivors, aged 13-25 years, who had completed treatment between one and ten years ago. Survivors completed a paper-based questionnaire, containing validated measures of SAD, and an optional semistructured interview assessing current social functioning and social anxiety. Results: Twenty-seven survivors aged 13-25 years participated (M = 19.15, 51.9% male, and 7 years post-treatment). Nine (33%) participants reported clinically significant symptoms of SAD. In interviews, survivors reported worries about how others perceived them and fears around meeting new people. Survivors described that this impacted their daily social functioning, leading them to avoid, or endure with distress, feared social situations. Conclusion: This study shows that clinically significant social anxiety may be a concern for a subset of survivors of childhood/adolescent cancer. Identifying which young people are at risk of SAD after cancer and how best to support this vulnerable cohort is critical.

Examining the expectations of healing care environment of hospitalized children with cancer based on Watson's theory of human caring

AIM

To describe the expectations of children with cancer about the healing care environment during hospitalization based on Watson's Theory of Human Caring.

DESIGN

A descriptive qualitative research design was used in this study.

METHODS

Data were collected between December 2019 and February 2020 from purposively selected children with cancer in a paediatric haematology and oncology clinic at a university hospital in Turkey. Twelve participants (7 females and 5 males) aged 10-17 were recruited to carry out individual semi-structured interviews. All interviews were recorded via a digital audio recorder and transcribed verbatim. The content analysis method was used to analyse the data.

FINDINGS

As a result of the analysis, three main themes with related sub-themes were identified that revealed the expectations of children with cancer: 'healing care behaviors', 'creating the physical environment of the hospital' and 'support from the social environment'.

CONCLUSION

Watson's Theory of Human Caring may be a useful and applicable guide for drawing a conceptual framework of the expectations of children with cancer regarding a healing care environment. The study revealed these children's need for humanistic, compassionate, honest and problem-focused care. In addition, participants wished for improvements in the physical environment. They also stated that they feel lonely and need social support from their family, peers and society.

IMPACT

This study presents a comprehensive picture of the expectations regarding a healing care environment (caring behaviours and physical and social aspects) of hospitalized children with cancer undergoing treatment. The qualitative findings generated by our study have the potential to facilitate these children's healthy adjustment to the hospital environment and procedures during hospitalization. Knowledge acquired through this study may be used to shape nursing care, enhance the healing care environment, and ensure that hospital design and setting are acceptable to and appropriate for paediatric patients.