Health related quality of life during cancer treatment: Perspectives of young adult (23-39 years) cancer survivors and primary informal caregivers

Effect of group online-based peer support intervention on psychological distress of adolescent and young adult cancer patients: a randomized controlled trial

PURPOSE

Adolescent and young adult (AYA) cancer patients, aged between 15 to 39 years old, suffer from long-term psychological distress, confronting low self-efficacy and various psychological problems. This study constructs a group online-based peer support intervention combined with offline activities to explore its impact on the psychological distress of AYA cancer patients.

METHODS

A randomized, two-arm clinical trial was conducted in which 90 AYA cancer patients were recruited. The control group (N = 45) received conventional psychological care and treatment, and the experimental group (N = 45) received 8 weeks of an online peer support intervention. Outcome measures included psychological distress (Distress Thermometer, DT), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), perceived peer support (Cancer Peer Support Scales, CaPSS), and readiness for return to work (Readiness to Return-To-Work Scale, RRTW).

RESULTS

Eight-week peer support intervention was effective in improving psychological distress, anxiety, and depressive symptoms in the experimental group with statistically significant differences (P < 0.05). Time affected psychological distress, anxiety, and depressive symptoms in AYA cancer patients (P < 0.05), and there was an interaction with intervention factors (P < 0.05). The intervention has a positive effect on relieving the psychological status of AYA cancer patients. For readiness for return to work, the experimental group was in the preparation for the action-behavioral stage immediately, 1 month and 3 months after the end of the intervention (P < 0.01), supporting AYA cancer patients who have not returned to work to maintain optimal return-to-work readiness.

CONCLUSIONS

The group online-based peer support intervention is popular and has good scientificity, effectiveness, and practical significance for AYA cancer patients.

TRIAL REGISTRATION

This study was registered at clinicaltrials.gov. (ChiCTR2100053091, registered on 10 November 2021).

Same Journey, Different Paths: Caregiver Burden among Informal Caregivers of Adolescent and Young Adult Patients with an Uncertain or Poor Cancer Prognosis (UPCP)

A minority of adolescent and young adult cancer patients (AYA) live with an uncertain or poor prognosis (UPCP). Caring for a young, advanced cancer patient can lead to caregiver burden. This study aims to provide insight into burden on informal caregivers of AYA cancer patients with UPCP. In-depth, semistructured interviews were conducted with parents (n = 12), siblings (n = 7), friends (n = 7), and partners (n = 13). Thematic analysis was performed to derive themes from the data. Participants reported sleeping problems and stress. They struggle with uncertainty, fear, loss, and negative emotions. Family life is altered due to solely taking care of the children, but also the AYA. Contact with friends and family is changed. The relationship to the AYA can shift positively (e.g., becoming closer) or negatively (e.g., more conflict or no longer being attracted). Participants were under pressure, having to take on many responsibilities and multiple roles. In the financial domain, they report less income and often must continue working. A high amount of caregiver burden is experienced among informal caregivers of AYAs with UPCP. Yet only part of the impact appears to be age specific. Specific, age-adjusted interventions can be developed to lower the burden.

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.

Caring for Adolescents and Young Adults (AYA) with Cancer: A Scoping Review into Caregiver Burdens and Needs

AYAs with cancer (aged 15 to 39 at primary diagnosis) form a specific group within oncology, and there is limited information on the impact on their informal caregivers. This scoping review aimed to gain insight into the burden on caregivers of AYAs with cancer and identify the unmet needs they might have. Eligible articles focused on impacts in one of the domains of caregiver burden (physical, psychological, social, on schedule, financial) or unmet needs. In all domains of caregiver burden, impact was reported by caregivers. Caregiving leads to physical problems (such as sleep problems) and psychological symptoms (e.g., depression, anxiety, and negative emotions). Loneliness is reported, and little peer-support. Many different tasks and roles must be undertaken, which is perceived as challenging. In addition, there is a financial impact and there are unmet needs to be met. Several domains of the lives of caregivers of AYA cancer patients are negatively affected by the disease. Some of these are age-specific, and tailored to a particular group of caregivers (parents, partners, or friends). AYA cancer patients represent a wide age range, resulting in the engagement of many different caregivers. Future research will need to take this into account in order to adequately provide support.

Taking Care of an Adolescent and Young Adult Cancer Survivor: A Systematic Review of the Impact of Cancer on Family Caregivers

Research usually investigates adolescents and young adults (AYA) with cancer in combination with younger and older cancer patients and survivors. However, AYAs with cancer are a unique group, and their caregivers' experience may also differ from other caregivers of cancer survivors. This systematic review aims to understand the impact of a cancer diagnosis on family caregivers, comparing the experience of caregivers of AYA childhood cancer survivors (AYA CCS) and caregivers of AYA with cancer. Relevant studies were identified through PubMed, Scopus, and Web of Science databases, and their quality was assessed using the Joanna Briggs Institute's critical appraisal checklists. Sixteen studies (17 reports) met the inclusion criteria. Findings were synthesized separately for caregivers of AYA CCS and caregivers of AYA with cancer. Results showed that caregivers in both groups experienced high distress after the diagnosis. Partners of AYAs with cancer experienced diminished quality of life (QoL) and over half reported moderate to high fear of cancer recurrence (FCR). Findings indicated that cancer negatively impacts family caregivers, regardless of the patient's age at diagnosis. However, findings are heterogeneous, and most do not focus on QoL or FCR. More research is needed on the impact of cancer among these family caregivers.

Caregivers with Cancer Patients: Focus on Hispanics

Cancer is a public health concern and causes more than 8 million deaths annually. Cancer triggers include population growth, aging, and variations in the prevalence and distribution of the critical risk factors for cancer. Multiple hallmarks are involved in cancer, including cell proliferation, evading growth suppressors, activating invasion and metastasis, resisting cell death, enabling replicative immortality, reprogramming energy metabolism, and evading immune destruction. Both cancer and dementia are age-related and potentially lethal, impacting survival. With increasing aging populations, cancer and dementia cause a burden on patients, family members, the health care system, and informal/formal caregivers. In the current article, we highlight cancer prevalence with a focus on different ethnic groups, ages, and genders. Our article covers risk factors and genetic causes associated with cancer and types of cancers and comorbidities. We extensively cover the impact of cancer in Hispanics in comparison to that in other ethnic groups. We also discuss the status of caregivers with cancer patients and urgent needs from the state and federal support for caregivers.

"Informal Caregiver" in Nursing: An Evolutionary Concept Analysis

The informal caregiver experience has surged as a research topic in health care, including in nursing. However, the "informal" language is controversial, lacking conceptual clarity. Without a common understanding of who an "informal caregiver" may be, nurses may fail to consistently identify informal caregivers requiring support. Therefore, a concept analysis of "informal caregiver" was conducted on the basis of a sample of 20% of relevant nursing literature. The analysis of the attributes, antecedents, consequences, and contexts associated with "informal caregiver" offers a foundational guide for the ongoing development of nurses' understanding of the informal caregiver role.

Comparing Fatigue, Loneliness, Daytime Sleepiness, and Stress in Younger and Older Breast Cancer Survivors: A Cross-Sectional Analysis

BACKGROUND

Breast cancer treatment can negatively affect psychosocial outcomes for breast cancer survivors (BCS), but these outcomes present differently for younger and older survivors.

OBJECTIVES

The objective of this study was to compare psychosocial outcomes between younger and older BCS and identify predictors of loneliness in younger BCS.

METHODS

This cross-sectional descriptive study of 90 BCS evaluated data on sociodemographic and clinical characteristics and self-reported measures of psychosocial outcomes (fatigue, depressive symptoms, anxiety, loneliness, daytime sleepiness, and stress). Participants were dichotomized into two groups by age (aged less than 50 years and aged 50 years or older). Descriptive statistics, bivariate correlations, and multiple regression were also examined.

FINDINGS

Younger BCS reported greater fatigue, loneliness, daytime sleepiness, and stress than older BCS. No between-group differences were found in depressive symptoms or anxiety. Having children and less time since chemotherapy completion were significant predictors of less loneliness in younger BCS.

Relationship of Circadian Rhythm and Psychological Health in Adolescents and Young Adults With Cancer

BACKGROUND

Evidence shows that adolescent and young adult (AYA) cancer patients have an increasing survival rate but experience psychological distress and circadian rhythm dysregulation. Little is known about the effect of circadian rhythm on psychological distress.

OBJECTIVE

To investigate the type of circadian rhythm in Chinese AYA cancer survivors and examine the associations among chronotype, demographic characteristics, psychological distress, anxiety and depression, character strengths, and medical coping in this group.

METHODS

This cross-sectional study enrolled 800 AYA cancer participants, 728 of whom completed the Chinese version of the Morningness-Eveningness Questionnaire, the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Medical Coping Modes Questionnaire.

RESULTS

Evening- and morning-type participants accounted for 35.0% and 19.1%, respectively, among participants, which was significantly higher than those found in the general population. The prevalence of psychological distress was 84.9% among AYA cancer participants. Exercise, Distress Thermometer, and depression were important predictive factors for the circadian rhythm.

CONCLUSIONS

Circadian rhythm disorder and psychological distress were common among AYA cancer survivors. Evening-type participants performed worse on character strength, confrontation, and avoidance of medical coping.

IMPLICATIONS FOR PRACTICE

Healthcare professionals need to understand the circadian rhythm and psychological health of AYA cancer survivors. Psychological rehabilitation guidance, especially within the 6 months after diagnosis, may benefit AYA survivors according to their chronotype. Character strengths can also be used during rehabilitation to properly guide AYA survivors.

The Psychosocial Impact of Spouse-Caregiver Chronic Health Conditions and Personal History of Cancer on Well-being in Patients With Advanced Cancer and Their Caregivers

CONTEXT

Caregiving during advanced cancer presents many physical and psychological challenges, especially for caregivers who are coping with their own history of cancer or their own chronic health conditions. There is growing recognition that caregiver health and patient health are interdependent.

OBJECTIVES

The objective of this study was to use quantitative and interview data to examine and explore the impact of a caregiver's personal cancer history and chronic health conditions on the psychosocial well-being of both the caregiver and patient.

METHODS

This was a secondary analysis of data from 88 patients with advanced lung/gastrointestinal cancer and their spouse-caregivers. Participants self-reported subjective health, chronic health conditions (including cancer), anxiety and depression symptoms, and social support and social stress. Caregivers self-reported caregiving burden and preparedness for caregiving. Caregivers also completed semistructured interviews.

RESULTS

Participants were mostly white, non-Hispanic, and in their mid-60s. Caregivers reported 1.40 (SD = 1.14) chronic conditions on average; 11 reported a personal history of cancer ("survivor-caregivers"). The number of caregiver chronic health conditions was positively associated with patient depression symptoms. Patients of survivor-caregivers also reported more depression symptoms than patients of caregivers without cancer (t(85) = -2.35, P = 0.021). Survivor-caregivers reported higher preparedness for caregiving than caregivers without cancer (t(85) = -2.48, P = 0.015). Interview data enriched quantitative findings and identified factors that may drive patient depression, including emotions such as resentment or guilt. Experiencing cancer personally may provide caregivers unique insight into the patient experience.

CONCLUSION

Providers should be aware of caregiver chronic conditions and cancer history, given the potential negative effects on patient psychosocial well-being.

Effect of Two Interventions on Sleep Quality for Adolescent and Young Adult Cancer Survivors: A Pilot Randomized Controlled Trial

BACKGROUND

Sleep disturbance is common among adolescent and young adult (AYA) cancer survivors. Physical activity (PA) and behavioral activation (BA) therapy have been reported as enhancing sleep quality, but few studies exist on the effects of such interventions combined with technology to promote sleep quality in AYA cancer patients.

OBJECTIVE

The aim of this study was to investigate the feasibility and effects of intelligent wearable device-based PA therapy and internet-based modified BA therapy to improve sleep quality among AYA cancer patients.

METHODS

A randomized controlled trial with 143 AYA cancer patients was conducted. Participants were randomly assigned to a control group (n = 48), which performed routine care, a PA group (n = 47), which received 8-week PA therapy based on intelligent wearable devices, and a BA group (n = 48), which participated in internet-based modified BA therapy for 8 weeks.

RESULTS

At 1 week and 3 months after the intervention for sleep quality, there were statistically significant differences between the PA group and the control group (P = .020), but no statistically significant difference between the BA group and the control group.

CONCLUSIONS

The intelligent wearable device-based PA therapy has more advantages than internet-based modified BA therapy in improving the overall state of AYA cancer patients, and the intervention effect was sustained for at least 3 months.

IMPLICATIONS FOR PRACTICE

Developing and implementing PA plans for AYA cancer survivors can improve their sleep quality. Social media, intelligent wearable devices, and mobile health applications have unique advantages in promoting sleep quality for AYA cancer survivors.

Informal caregivers' quality of life and management strategies following the transformation of their cancer caregiving role: A qualitative systematic review

Objectives

Globally, informal caregivers caring for cancer patients meet challenges within their caregiving role, which significantly influence their quality of life. This qualitative systematic review aimed to analyze how cancer caregiving influence the quality of life of informal caregivers and the management strategies of informal caregivers for their role as cancer caregivers.

Methods

Following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement, Wanfang database, the China National Knowledge Infrastructure (CNKI), CINAHL, MEDLINE, PubMed, Cochrane Library, PsycARTICLES and PsycINFO, and grey literature in English and Chinese from 1 May 2009 to 31 December 2019 were searched. Quality of included studies was assessed by the Critical Appraisal Skills Programme (2018) Qualitative Checklist and thematic synthesis was conducted.

Results

Of the 8,945 studies identified, 6 studies met the inclusion criteria. One analytical theme relating to the QoL of informal caregivers following cancer caregiving was identified: "challenges of caregiving". In terms of the management strategies to the role of cancer caregivers, two analytical themes were identified: "self-adjustment" and "seeking for formal and informal support".

Conclusions

Cancer caregiving influences informal caregivers' QoL significantly and informal caregivers develop diverse coping strategies to deal with the difficulties occurred while balancing the relationship between their own lives and caregiving. However, professional and policy support remain inadequate for informal caregivers that require the need for improvement in terms of health care professionals and policymakers.

Identification of Evidence for Key Positive Psychological Constructs in Pediatric and Adolescent/Young Adult Patients with Cancer: A Scoping Review

Introduction: Children and adolescents/young adults (AYAs) with cancer are a vulnerable population susceptible to numerous late effects, such as fatigue and depression, which may diminish their long-term psychological, physical, spiritual, and emotional health. A well-rounded understanding of how positive psychological constructs affect the quality of care and treatment outcomes is therefore warranted.

Methods: We conducted a scoping review of 15 positive psychological constructs in children and AYAs with cancer. The primary research questions were (1) what is known about positive psychological constructs in children and AYAs with cancer; (2) what value is ascribed to these constructs by patients?

Results: Two hundred seventy-six articles were included after database search and screening. These studies were mostly observational or qualitative and conducted in North America. Constructs were often poorly defined, and measurement tools used to gather data were wide ranging. Numerous factors were correlated with increased or decreased expression of certain constructs, but overall themes were difficult to identify. Similarly, patients often spoke of what increased or decreased expression of a construct, with less emphasis on what they implicitly value.

Discussion: This scoping review found ample evidence for what increases or decreases expression of positive psychological constructs, but this evidence was observational and often conflicting. In the future, we recommend the development of a core set of psychological outcomes, with definitions and corresponding measurement tools. We further recommend an emphasis on randomized trials to more rigorously study how expression of constructs can be improved and what effect this has on the quality of life.

Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature

OBJECTIVE

Caregivers for patients with cancer have an integral role in maintaining patients' health. Although patients and caregivers experience the impact of cancer individually, studies suggest their health is interdependent. The objective of this review was to synthesize the literature on interdependent physical and psychological morbidity in patient-caregiver dyads published since 2016.

METHODS

A search of PubMed, CINAHL, Embase, and PsycInfo databases was performed using Cooper's recommendations and the Preferred Reporting Items for Systematic Reviews And Meta-Analyses Guidelines. Studies were included if they measured individual physical or psychological morbidity in cancer patient-caregiver dyads, evaluated interdependence, and were published in a peer-reviewed journal.

RESULTS

Twenty-three studies met criteria, characterized by mainly spousal dyads. Studies included a variety of cancers and methodologies. Findings were inconsistent, indicating varying interdependence. However, the studies demonstrated a stronger relationship between patients' and caregivers' psychological morbidity than between their physical morbidity.

CONCLUSIONS

This review revealed a need for continued exploration of dyadic health interdependence. Future studies should consider samples of patients with a single type of cancer, testing cultural mediators/moderators, and using longitudinal designs.

"The day you lose your hope is the day you start to die": Quality of life measured by young women with metastatic breast cancer

Purpose/Objectives: The number of young women with metastatic breast cancer (MBC) is growing in the United States. The intersection of age and cancer stage presents unique challenges for this population. However, there is little extant research on the concerns and perspectives of young women with MBC. The purpose of this study is to understand how young women describe their lived experiences following their diagnoses of MBC.Design: A cross-sectional qualitative study with a life course theoretical framework was employed.Sample/Participants: Purposive sampling yielded nine participants who took part in semi-structured interviews. Phenomenology informed understanding of the lived experience of young women with MBC.Findings: The findings describe how young women with MBC measure quality of life, via themes of facing off-time diagnoses, strategizing disclosure, relying on mindfulness and spirituality, contemplating the future, and differentiating surviving from truly living.Conclusion: The notion of short-term or long-term decision-making is clouded by a metastatic prognosis.Implications for Psychosocial Providers: These findings present new information about the needs of young women with MBC, with potentially transferable implications for young adults with other forms of metastatic cancer.

Cancer, a relational disease exploring the needs of relatives to cancer patients

Purpose: In this qualitative interview study we investigated the experiences of family members to cancer patients. Our objective was to explore and to differentiate their needs from the needs of cancer patients.

Methods: Five focus groups and six individual narrative interviews with 17 family members to cancer patients in Sweden were conducted and compared with 19 cancer patient interviews. Our analysis was inspired by classic grounded theory.

Results: Family members to cancer patients expressed own morbidity connected to high stress levels and difficulties in recognizing own stress due to ongoing comparisons with the cancer patient. Family members were trapped in a momentary terror-like situation where they became their sick relative’s safety net. A percieved inability to improve their loved one’s well being contributed to a feeling of guilt. The longing for it all to end was encumbered with shame since the end included possible death.

Conclusions: By recognizing cancer as a disease striking both body and relationships, family members are given precedence over their own struggles, differentiated from the patient’s experiences. We define differences in needs between cancer patients and family members. Family members to cancer patients may be supported in developing balancing strategies towards less stress, increased safety and moments of contentment.

The Impacts of Depression Treatment on Health-Related Quality of Life in Cancer Patients: A Systematic Review

Introduction: Cancer diagnosis can have a profound negative impact on the health-related quality of life (HRQoL) of cancer patients. Cancer patients also suffer from psychological pressures including sadness, depression, hopelessness, anxiety and worry. The literature review was employed to determine the effects of depression on health-related quality of life (HRQoL) in cancer patients.Methods: A systematic review was conducted by searching the Science Direct, Scopus and Google Scholar databases. The integrative review of the 10 articles was focused on the 10 years period from 2008 to 2018. The language used was English and the search was conducted using predefined keywords.Results: All of the journals discussed the impact of depression treatment on health-related quality of life in cancer patients. Based on all of the journals, depression can be reduced by health education, physical activity and medicine therapyConclusion: Despite the treatment for depression, the patient’s HRQoL did not improve during the measurement timeframe. Quality of life is a priority health outcome in cancer treatment but the clinical approaches to ameliorate depression in cancer patients appear to be suboptimal.

The effect of progressive muscle relaxation on cancer patients' self-efficacy

BACKGROUND AND PURPOSE

Self-efficacy is considered as one of the influential parameters affecting the health of patients. This study aimed to investigate the effect of relaxation techniques on self-efficacy of patients suffering from cancer.

MATERIALS AND METHODS

This study was a clinical trial in which 80 patients suffering from cancer were randomly assigned to two groups of experimental and control. Data collection instruments consisted of demographic information and Strategies Used by People to Promote Health questionnaires. In the experimental group, the patients performed relaxation techniques once a day for 30 min over two months. In the control group, the patients received the routine care.

RESULTS

A statistically significant difference was observed between the mean self-efficacy indices in the experimental group (p = 0.001). There was no significant difference in the control group (p = 0.3).

CONCLUSION

Muscle relaxation can enhance self-efficacy of cancer patients. Therefore, it can be used as an alternative method for patients who are willing to use this technique.