The adolescent with cancer

"Others Like Me". An Approach to the Use of the Internet and Social Networks in Adolescents and Young Adults Diagnosed with Cancer

The purpose of this study is to improve comprehension about how adolescents and young adults (AYA) diagnosed with cancer use the Internet and social networks to seek information about their illness and to establish relationships between them. A group of 20 AYA patients and survivors of cancer (ages 14 to 29) were interviewed from a qualitative approach. Most of the respondents (N = 16) sought information about their disease on the Internet. They looked for information using search engines (mainly Google) and general concepts as their own cancer name. In general, they did not share the information obtained with their parents or professional healthcare providers. The interviewees think that the information is difficult to understand because of jargon and that it is not aimed at a young audience. All (N = 20) have presence in social networking sites. AYAs with cancer are starting to create content themselves: three started a blog in order to explain their experience to others like them. The study shows that is necessary to increase efforts on adapting content to these age groups in order to help them learn more about their own disease. This may contribute to increment their adherence to treatment and to maintain surveillance of potential consequences and health problems post-treatment.

Adolescents with Cancer and Occupational Deprivation in Hospital Settings: A Qualitative Study

Objective/Background

The aim of this article was to analyze the needs of hospitalized adolescents with cancer in relation to the performance of meaningful activities as well as to explore the possible scenarios of occupational deprivation in hospital paediatric wards.

Methods

The study follows an ethnographical research approach using two techniques: participant observation and in-depth interviews, with constant comparison by data triangulation. Eight adolescents diagnosed with cancer aged between 15 years and 19 years (5 males and 3 females) were recruited from Toledo and Madrid in Spain.

Results

Five themes revealing the needs of adolescents with cancer in hospital environments were identified: (a) educational needs, (b) leisure needs, (c) physical space of the rooms, (d) interaction with medical personnel, and (e) lack of specific wards for adolescents.

Conclusion

The lack of variety and availability of educational activities and leisure, and the subsequent changes of the individual physical, social, and cultural environments could cause situations of occupational deprivation, and also affect the health and quality of life of the individuals.

The Clinician's Toolbox: Assessing the Sexual Impacts of Cancer on Adolescents and Young Adults with Cancer (AYAC)

INTRODUCTION

Adolescents and young adults aged 15-39 years who have been diagnosed with cancer (AYAC) have unique medical and psychosocial needs. Following their cancer treatments, AYAC must learn to manage the sometimes irreversible general side effects of cancer treatments including side effects that impact their sexuality. These side effects include but are not limited to: infertility, altered body/physical appearance, and sexual dysfunction. Such effects may hinder AYAC efforts to date and experiment sexually, limiting sexual maturation and confidence, as well as the formation or maintenance of meaningful couple and sexual relationships. It is clear that we need to tailor our clinical approaches to ensure that we assess the unique needs and concerns faced by AYAC.

AIMS

Based on consistent study findings substantiating the distinctive needs of AYAC, the main objective of this article is to present the core clinical components involved in assessing sexuality among AYAC.

METHODS

The clinical recommendations are based on the authors and experts' clinical experiences coupled with a thorough examination of the literature related to AYAC sexuality.

MAIN OUTCOME MEASURES

This article first describes the three components (clinical interview, review of chart notes, and self-report questionnaires) of a sexuality assessment and the seven core domains that highlight target areas of focus.

RESULTS

A detailed outline of each of the core domains of assessment (socio-demographics; medical history; fertility and sexually transmitted infection; sexual functioning; sexual coping style; body and self-image; and sexual history and dating/couple experience) is presented. A "toolbox" table containing useful resources for clinicians (e.g., questionnaires and red flags) and direct resources for AYAC patients are included.

CONCLUSION

Cancer can have a significant impact on numerous domains of AYAC sexuality. The assessment of and attention to the impact of sexuality on AYAC is crucial in order to provide effective and comprehensive quality patient cancer care.

Adolescents and young adults with cancer: An orphaned population

Adolescents and young adults (AYAs [15 to 29 years of age]) with cancer have a distinct cancer epidemiology, evolving hormonal milieu, maturing development, transitions in autonomy, increasing demands in education, entry into the workplace and family responsibilities. The prevalence of epithelial cancers in AYA patients represents a major shift from the embryonal cancers that predominate in early childhood. Thus, one would expect a specialized expertise to be required in caring for these patients, who typically fall between paediatric and oncology spheres of practice. Complex issues contribute to the lower survival rates noted for AYAs compared with those of younger patients, even with the same cancer. Cooperative group clinical trial participation has been crucial in advancing the excellent outcomes accomplished in paediatric oncology, yet participation by adolescents in clinical trials (either adult or paediatric) is typically low. There is increasing evidence that both appropriate location of care and access to specialists in paediatric or adult oncology contribute to favourable outcomes. Issues specific to AYA patients should be studied rigorously so that evidence-based approaches may be used to reduce waiting times, ensure prompt referral to appropriate centres, increase accrual to clinical trials, foster compliance, provide comprehensive supportive care and promote programs designed to enhance survivorship.

The experience of uncertainty in young adults with cancer

The purpose of this qualitative descriptive study was to describe the experience of uncertainty in young adults with cancer. A purposeful sample of 6 young adults between the ages of 19 and 30 years undergoing chemotherapy treatment was recruited. Participants were interviewed twice using semistructured interviews. The investigators used constant comparison to examine the content of the transcript for common words, phrases, statements, or units of text that related to uncertainty. Findings revealed 3 major emerging themes. The first one being "types of uncertainty," which includes uncertainty and efforts at the right place, uncertainty and aspects of treatment, uncertainty and personal abilities, and uncertainty and the feasibility of plans related to life goals. Uncertainty was also found to trigger the development of certainties, which led to the second theme, "certainties: helpful or not?" A third emerging theme, dealing with uncertainty, described a variety of strategies used by young adults that included living on a day-to-day basis, being selfish, believing, getting information, trusting the physician, concentrating on positive things, keeping energy by pacing oneself, choosing social support, and trying to live a normal life. A consequence of dealing with the uncertainty and the cancer journey is the "enlightened path." It emerged and revealed how the cancer journey changed their lives. A number of implications for nursing practice therefore warrant consideration, especially fostering a sense of normalcy by identifying common behaviors, feelings, or needs among these young adults with cancer. Sharing this information and facilitating interactions with other young adults with cancer has the potential to promote coping with uncertainty.

Information and service needs for young adult cancer survivors

BACKGROUND

The intent of this study was to examine supportive care needs and preferences among young adult cancer survivors.

METHOD

Eight hundred seventy-nine young adults aged 18-39 years at time of study and diagnosed with cancer between the ages of 15-35 completed an online survey. Questions assessed the extent to which subjects had utilized various information and supportive care services and/or expressed a desire to use those services either now or in the past.

RESULTS

Upwards of 60% of respondents expressed a desire or need for age-appropriate cancer information, information about diet, exercise, nutrition, complementary and alternative health services, infertility information, mental health counseling, and camp or retreat programs for young adults. In most cases, more than 50% of respondents indicated that their needs for information and services have been unmet. In addition, unmet needs were more likely reported by respondents who were younger at age of diagnosis, of poor physical health status, and less likely to be advanced in work, school, or a committed/marital relationship. Other significant differences in unmet need were observed across sociodemographic and health status variables.

CONCLUSION

Findings suggest a need to enhance the provision of supportive care services to adolescent and young adult cancer survivors along a continuum of care, from diagnosis through treatment and on to off-treatment survivorship.

Using plain language skills to create an educational brochure about sperm banking for adolescent and young adult males with cancer

Writing in plain language makes it easier for patients to read, understand, and make informed decisions about sperm banking. Greater attention to the issue and properly designed educational brochures for use by nurses in oncology and reproductive health is of evident importance but of unknown impact. A multidisciplinary clinical team followed an evidence-based, patient-centered approach to develop "plain language" patient education materials about sperm banking for adolescent and young adult (AYA) males with cancer. A patient education booklet was produced and implemented as part of the planned patient education for AYA male oncology patients at McMaster Children's Hospital, Hamilton Health Sciences, in Hamilton, Ontario, Canada. The patient education booklet for use by health professionals as a teaching tool to facilitate discussion with AYA males has been produced with the hope that it will contribute to better informed decision making regarding sperm banking and increased use of this technology for fertility preservation.

Effectiveness of sperm banking in adolescents and young adults with cancer

BACKGROUND

Improving success in the treatment of cancer has resulted in an increasing number of survivors. An important quality of life issue among younger survivors is the ability to have a family. Current gonadotoxic treatments for cancer pose a challenge to future fertility. Preservation of fertility after gonadotoxic therapy is an important consideration for these patients. In a regional center, the authors evaluated efficacy and utilization of sperm banking for preservation of male fertility in adolescents and young adults (AYA) with cancer.

METHODS

A retrospective chart review was conducted to obtain data on clinical features, andrology, and fertility from patients (ages < 30 years) who cryopreserved samples of semen from 1995-2005.

RESULTS

Of 821 newly diagnosed male AYA cancer patients, aged 14-30 years, only 146 (17.8%) used sperm cryopreservation technology. Patients who used their cryopreserved semen for attempted conception had a 36.4% success rate with intrauterine insemination (IUI) and a 50.0% clinical pregnancy rate with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

CONCLUSIONS

Sperm cryopreservation by AYA males with cancer is an efficacious method for preserving future fertility. Awareness and employment of assisted reproductive technologies needs to be implemented by an interdisciplinary team of experts caring for these patients and can result in successful paternity in males after treatment for cancer.

Coping in Adolescents with Cancer

The dual challenge of normal adolescent development combined with a diagnosis places high demands on the coping of adolescents with cancer (AWC). A review was conducted to synthesize and critique studies of coping in AWC. Findings from this review indicated inconsistent results for developmental and gender differences as well as associations of coping with distress. A number of limitations were associated with these studies, including the use of small samples, lack of consistency in the conceptualization of coping and instruments, and limited knowledge helpful to inform intervention research to improve effective coping in AWC. Future studies are needed to address these limitations.

Researching chronic childhood illness: the example of childhood cancer

OBJECTIVES

To provide an overview of issues raised by conducting research in the area of chronic childhood illness, using the example of childhood cancer.

METHODS

This literature review used informal methods.

RESULTS

Children with cancer and their families may participate in a wide variety of studies in different research traditions, including social science studies, epidemiological, biological and genetic research, and clinical trials. Different concerns about research participation have been raised in these different contexts. Sociological debate has tended to characterize exclusion from research as a manifestation of assumptions of poor competence on the part of children, and to see inclusion in research as a means of restoring proper balance in power relations and giving children a voice. The ethical imperative within clinical research, on the other hand, has been in favour of protection of individuals from risk or direct harm. Lack of consensus on issues such as the status of children's consent for research participation persists, in part because debates have taken place within rather than across disciplinary boundaries, and in part because of a tendency to debate issues as ethical principles in an empirical vacuum. The lack of research on the experiences and views of those asked to take part in childhood cancer research is striking.

DISCUSSION

It is important that debates about the involvement of children in research are informed by high-quality social science research and by interdisciplinary dialogue.

Social support and adolescent cancer survivors: a review of the literature

With survival rates increasing dramatically in pediatric cancer, concern has increasingly focused on the psychosocial aspects of the cancer experience. Clearly, the experience of a cancer diagnosis and treatment of cancer places high demands on the coping of adolescents. Research has shown social support to be effective in decreasing stress and enhancing coping in adolescents facing such demands. A review and critical analysis of studies of social support in adolescent cancer survivors was conducted. The seventeen studies were mainly descriptive and exploratory in nature with social support examined for a number of outcome variables in eight of the studies. Findings from this review indicate that support from parents (especially the mother) and friends were extremely important and that the adolescents were satisfied with family support. Support from friends was described as less satisfactory. Methodological concerns of the reviewed studies include small samples and a lack of consistency in the instruments used to assess social support. Future studies of social support for adolescent cancer survivors should include larger samples to determine gender, age group, and ethnic differences and to allow the examination of social support theoretical models specific to the developmental and chronic illness situation of these adolescents.

Leaving home after cancer in childhood: a measure of social independence in early adulthood

BACKGROUND

Previous studies on psychosocial outcomes for childhood and adolescent cancer survivors have found diverse results concerning social independence. As a measure of social independence, we investigated whether cancer survivors displayed the same patterns of leaving home as population-based control group.

PROCEDURE

We identified 1,597 patients in the Danish Cancer Register, born in 1965-1980, in whom a primary cancer was diagnosed before they reached the age of 20 in the period 1965-1995. The patients were compared with a random sample of the general population (n = 43,905) frequency matched on sex and date of birth. By linking the two cohorts to registers in Statistics Denmark, we obtained socioeconomic data for the period 1980-1997. The relative risk for leaving home was estimated with discrete-time Cox regression models.

RESULTS

The risk for leaving home of survivors of hematological malignancies and solid tumors did not differ significantly from that of the control cohort. Adjustments for possible socioeconomic confounders did not change this pattern. In contrast, survivors of central nervous system (CNS) tumors had a significantly reduced risk for leaving home, which was most pronounced for men (relative risk, men: 0.66; 95% confidence interval, 0.55-0.80; women: 0.88, 95% confidence interval, 0.80-0.97).

CONCLUSION

Overall, the psychosocial effects of cancer in childhood or adolescence and its treatment on the survivor and family did not appear to impede social independence in early adulthood, except for survivors of CNS tumors.

Health status and health-related quality of life in adolescent survivors of cancer in childhood

PURPOSE

Adolescent survivors of cancer in childhood face particular challenges due to their maturational trajectory, including psychosocial adjustments, self-help skills, intellectual functioning and socialization. To better understand these, we assessed the health status and health-related quality of life (HRQL) in a 20-year cohort of such survivors in a single institution.

METHODS

Health status and HRQL were measured with a self-complete questionnaire from the Health Utilities Index (HUI) family of multi-attribute, preference-based instruments that provide utility scores for single attributes and overall HRQL.

RESULTS

Eighty-four (42 males, 42 females) of 129 eligible subjects (65%) participated. More than 80% of the respondents reported some form of morbidity. Overall HRQL utility scores were lower for both the males and females than for corresponding members of the Canadian general population. Female survivors self-reported a significantly greater burden of morbidity (mean overall HUI2/HUI3 scores: .83/.73 vs. .90/.84 for males, p < .02), which was most evident in the attributes of emotion and cognition.

CONCLUSIONS

The majority of adolescent survivors of cancer in childhood carry a morbidity burden into their teen and young adult years. These findings may guide the support required by this population.

Cancer surveillance and control in adolescents--similarities and contrasts between Canada and the United States

Opportunities for cancer prevention in adolescents range from limitation of sun exposure to the use of human papillomavirus vaccines. Those who develop malignant disease experience longer waiting times for diagnosis and treatment than do children, especially when referred to adult treatment centers, and they are less frequently enrolled in clinical trials. More attention to developmentally appropriate psychological support, enhancement of compliance/adherence, health promotion, and palliative care is needed. Improving cancer surveillance and control in adolescents in North America will require co-ordinated national efforts, involving pediatric and adult health care providers, institutions, and multiple levels of government.

Cancer incidence among adolescents in France

BACKGROUND

In France, cancer ranks third as the most significant cause of mortality in young people. However, the incidence, the survival, and the management of adolescent cancers have never been studied. The aim of this study is to investigate incidence rate (IR) of adolescents with cancer from data recorded in French Cancer Registries covering eight administrative areas, representing 10% of the French population, over a 10-year period (from 1988 to 1997).

PROCEDURE

Data from the FRANCIM network of French population-based Cancer Registries were used to analyze cancer incidence among adolescents aged from 15 to 19 years, excluding basal cell carcinomas of skin.

RESULTS

In total, 699 cases were recorded. Of these, 22.9% were lymphomas, 12.7% germ-cell tumors, 11.9% leukemias, 10.6% central-nervous-system tumors, 10.0% bone neoplasms, 7.6% soft-tissue sarcomas, and 19.5% tumors of adulthood (thyroid carcinomas 4.9%, melanomas 9.0%, and other carcinomas 5.6%). The overall IR was 172.9 per million adolescents (M/F: 1.2) with an annual increase of 3% (P = 0.58). Over the two 5-year periods (1988-1992 and 1993-1997) the IR increases significantly for malignant melanomas (respectively 10.4 and 21.2; P = 0.04).

CONCLUSIONS

Our findings are similar to that reported by previous studies performed in European and North-American countries. Future studies need to focus on the etiology explaining the increase in incidence, the management and the impact of the type of care on outcomes.

Starting an adolescent cancer unit: why does it take so long?

A pragmatic approach is discussed based on the authors' differing experiences while designing new units specifically for adolescents with cancer in Leeds and Newcastle upon Tyne. Planning and implementation are complex and very time consuming. Areas to be considered include: formally identifying needs and adapting to existing local circumstances, convening a working group and involving potential stakeholders at an early stage, designing a suitable physical space, recruiting and integrating staff to create a supportive environment, obtaining financial support, and developing operational policies. For successful running of an adolescent unit, old prejudices must be disavowed and new models of medical care considered.