1
|
Cacciotti C, Chevalier LL, Medeiros-Nancarrow C, Recklitis C, Cooney TM. The effect of pediatric central nervous system tumors on identity in young adult survivors: a project REACH study. J Cancer Surviv 2023; 17:1347-1358. [PMID: 35064553 DOI: 10.1007/s11764-022-01172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Of all childhood cancers, adult survivors of pediatric central nervous system (CNS) tumors are at the highest risk for late mortality as well as neurocognitive, physical, and psychosocial late effects. Their identity with cancer survivorship, the relationship of their identity to health outcomes, and how their identity differs from other childhood cancer survivors is poorly understood. METHODS A total of 127 young adults previously treated for pediatric CNS tumors enrolled in Project REACH, a locally-treated childhood cancer survivor cohort. Participants completed self-report measures on the effects of cancer on identity, someone who had cancer, victim and survivor identity, frequency of thoughts of diagnosis, and health outcomes. RESULTS The majority of participants identified as a survivor (83%). Survivor identity was linked to diagnosis and treatment but not health outcomes. A minority (9%) endorsed a victim identity, and they were more likely to have poorer mental health (p = 0.03) and depression (p = 0.04) than non-victims. Participants who reported a stronger effect of cancer on their identity also had poorer mental health (p = 0.005). A higher frequency of diagnosis-related thoughts was associated with significantly poorer mental health (p < 0.001), more severe anxiety (p = 0.008), depression (p < 0.001), and neurocognitive impairments (p < 0.01). Those who experienced relapse, radiation, and/or chemotherapy were more likely to identify as someone who had cancer, independent of diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Our findings suggest the relationships previously reported between identity and sociodemographic, treatment, and health outcomes after adult and pediatric non-CNS cancers cannot be generalized to pediatric CNS tumors. Understanding the unique features of how this population identifies is important for patient-centered care.
Collapse
Affiliation(s)
- Chantel Cacciotti
- Dana Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA.
- Division of Pediatric Hematology/Oncology, Western University, London, ON, USA.
- Department of Pediatric Hematology/Oncology, London Health Sciences, 800 Commissioners Road East, Rm B1-114, London, ON, N6A 5W9, USA.
| | - Lydia Larocque Chevalier
- Perini Family Survivors' Center, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
| | - Cheryl Medeiros-Nancarrow
- Perini Family Survivors' Center, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
| | - Christopher Recklitis
- Perini Family Survivors' Center, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
| | - Tabitha M Cooney
- Dana Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA, USA
| |
Collapse
|
2
|
Jensen MAE, Mørch CD, Yilmaz MN, Feilberg C, Pedersen B. A new self-understanding as chemo sufferer - a phenomenological study of everyday life with chemotherapy induced neuropathy among survivors after colorectal cancer. Int J Qual Stud Health Well-being 2022; 17:2049437. [PMID: 35315728 PMCID: PMC8942531 DOI: 10.1080/17482631.2022.2049437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Marlene AE. Jensen
- Department of Oncology, Clinic for Surgery and Cancer treatment, Aalborg University Hospital, Denmark
| | - Carsten D. Mørch
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette N. Yilmaz
- Department of Oncology, Clinic for Surgery and Cancer treatment, Aalborg University Hospital, Denmark; Clinical Cancer Research Centre, Aalborg University Hospital, Denmark
| | - Casper Feilberg
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Birgith Pedersen
- Department of Oncology, Clinic for Surgery and Cancer treatment, Aalborg University Hospital, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
3
|
Thavakugathasalingam M, Schwind JK. Experience of childhood cancer: A narrative inquiry. J SPEC PEDIATR NURS 2022; 27:e12367. [PMID: 35005836 DOI: 10.1111/jspn.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/08/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To more fully understand the possible impact of childhood cancer on a young person's life through their own story. DESIGN AND METHODS Using Connelly and Clandinin's narrative inquiry method, a participant named Noelle was engaged in a series of narrative interviews and a creative self-expression activity about her cancer experience when she was 12. Her story was examined through the three-dimensional space of experience (person, place, and time), and analyzed using Erikson's Psychosocial Stages of Development framework theoretical lens. RESULTS Two significant narrative patterns emerged: identity and relationships. Although the physical effects of the cancer were successfully treated, the impact of this disease impacted Noelle's own psychosocial development as she was trying to evolve her relationships with peers and family, while grappling with her new identity as a cancer patient. PRACTICE IMPLICATIONS Healthcare professionals need to intentionally increase their sensitivity to adolescent patients' lived experience of cancer. More specifically, there is a need for further education of healthcare professionals on the psychosocial impact of cancer in both the immediate and long-term trajectory of the cancer disease process.
Collapse
Affiliation(s)
| | - Jasna K Schwind
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Chevalier LL, Zwemer EK, Casey R, Recklitis CJ. The Effect of Pediatric Cancer on Identity in Young Adult Survivors: Results from Project REACH. J Adolesc Young Adult Oncol 2021; 11:297-303. [PMID: 34677115 DOI: 10.1089/jayao.2021.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: Living through cancer can have a profound effect on identity. Among those treated for adult-onset cancer, identifying as a cancer survivor is common and has been linked to positive mental and physical health outcomes. Although childhood is a critical period for identity formation, comparatively less is known about identity development after pediatric cancers. Methods: One hundred seventy young adults previously treated for pediatric cancer enrolled in Project REACH, a prospective cohort study, and completed self-report measures on effect of cancer on identity (e.g., cancer victim and survivor identity), frequency of thoughts of cancer, health outcomes (i.e., anxiety, depression, and health-related quality of life), and health behaviors (i.e., smoking, sun protection, exercise, and binge drinking). Results: The majority of participants identified as a survivor (n = 146, 85.9%), and survivor identity was linked to significantly higher anxiety (p = 0.01) and worse overall mental health (p = 0.04), but no other health outcomes or behaviors. Only 14 participants (8.2%) endorsed the victim identity, and they were significantly more likely to report binge drinking (p = 0.03) and worse overall mental health (p = 0.02) than nonvictims. Frequency of thoughts of cancer and effect of cancer on identity were also significantly associated with health outcomes (e.g., more frequent thoughts associated with higher anxiety). Conclusions: Our findings suggest that what is known about the relationship between identity and health outcomes after adult-onset cancer cannot be generalized to pediatric cancers, and that clinicians should not assume survivor identity is associated with better health outcomes in this group.
Collapse
Affiliation(s)
- Lydia L Chevalier
- Perini Family Survivors' Center, Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Eric K Zwemer
- Perini Family Survivors' Center, Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert Casey
- Perini Family Survivors' Center, Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher J Recklitis
- Perini Family Survivors' Center, Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
When Cancer Is the Self: An Interpretive Description of the Experience of Identity by Hematology Cancer Patients. Cancer Nurs 2021; 45:E504-E513. [PMID: 34352803 PMCID: PMC8849130 DOI: 10.1097/ncc.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The term "cancer" is imbued with identity signals that trigger certain assumed sociocultural responses. Clinical practice with hematological cancer patients suggests the experience of these patients may be different than that of solid tumor cancer patients. OBJECTIVE We sought to explore the research question: How are identity experiences described and elucidated by adult hematological cancer patients? METHODS This qualitative study was guided by interpretive description as the methodological framework. RESULTS Preexisting identity labels and assumptions assigned to the overarching "cancer" diagnosis were viewed by patients as entirely inadequate to fully describe and inform their experience. Instead, findings revealed the propensity of adult hematology oncology patients to co-create and enact new identities increasingly reflective of the nonlocalized nature of their cancer subtype. Three themes that arose from the data included the unique cancer-self, the invasion of cancer opposed to self, and the personification of the cancer within self. CONCLUSIONS Hematology oncology patients experience and claim a postdiagnosis identity that is self-described as distinct and highly specialized, and are distinct to solid tumor patients in aspects of systemic and total consumption of the self. This uniqueness is extended to the specific hematological cancer subtype down to genetics, indicating a strong "new" sense of self. IMPLICATIONS FOR PRACTICE The manner in which hematology oncology patients in this study embraced notions of transformed self and isolating uniqueness provides practitioners with a lens through which new and innovative interventions can be constructed to improve patient care and psychosocial outcomes.
Collapse
|
6
|
Sharin UBM, Hwang CCJ, Ang WHD, Lopez V. The haematopoietic stem cell transplant survivors' sense of coherence about their experiences: a qualitative study. Support Care Cancer 2020; 28:4275-4283. [PMID: 31900616 DOI: 10.1007/s00520-019-05273-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To explore the experiences of haematopoietic stem cell transplant survivors attending the long-term follow-up unit. METHODS A descriptive qualitative study of eight post-haematopoietic stem cell transplant survivors which were interviewed guided by the sense of coherence framework. Thematic analysis was used to extract meaningful explication of the survivors' experiences. RESULTS The post-haematopoietic stem cell transplant survivors interviewed were five females and three males with age ranging from 27 to 67 years and had the stem cell transplant between 4 and 20 years. Three main themes emerged from the data including (1) comprehending the experience, (2) acknowledging the meaningfulness of the experience and (3) managing threats to a new life after the transplant. The experiences of post-haematopoietic stem cell transplant survivors were initially difficult but they were able to make re-adjustments to their new life by reconciling with their new identity, refocusing on meaningful activities, strengthening their resilience and navigating the healthcare system. CONCLUSION In spite of the difficulties faced by the survivors, they were able to face the challenges and made adjustment in a positive light by focusing on the valuable aspects of their experiences. Health care practitioners need to continually support them throughout their survivorship journey no matter how long it takes. Any long-term follow-up unit is a step in the right direction to meet the complex needs of the survivors by integrating and adapting clinical guidelines into routine oncologic and transplant care so that survivors are not lost in transition following treatment.
Collapse
Affiliation(s)
| | | | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Violeta Lopez
- School of Nursing, Hubei University of Medicine, 30 South Remin Road, Shiyan, 442000, Hubei Province, China.
| |
Collapse
|
7
|
Greenblatt A, Saini M. Experiences of adolescents with cancer from diagnosis to post-treatment: a scoping review. SOCIAL WORK IN HEALTH CARE 2019; 58:776-795. [PMID: 31311459 DOI: 10.1080/00981389.2019.1640338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 05/19/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
Adolescence is a turbulent time of transition. Facing a serious health issue such as cancer during this time can be challenging and confusing. This study presents a scoping review of 33 research articles including quantitative, qualitative, mixed method, and reviews focused on the experiences of adolescents throughout the cancer journey. Extracted themes across studies identified individual, interpersonal, and environmental aspects of adolescents' experiences in each stage of this trajectory. Implications for these findings are discussed including a need for early diagnosis and treatment of adolescent cancers and developmentally appropriate clinical supports.
Collapse
Affiliation(s)
- Andrea Greenblatt
- Factor-Inwentash School of Social Work, University of Toronto , Toronto , Ontario , Canada
| | - Michael Saini
- Factor-Inwentash School of Social Work, University of Toronto , Toronto , Ontario , Canada
| |
Collapse
|