1
|
Figueroa Gray MS, Shapiro L, Dorsey CN, Randall S, Casperson M, Chawla N, Zebrack B, Fujii MM, Hahn EE, Keegan THM, Kirchhoff AC, Kushi LH, Nichols HB, Wernli KJ, Sauder CAM, Chubak J. A Patient-Centered Conceptual Model of AYA Cancer Survivorship Care Informed by a Qualitative Interview Study. Cancers (Basel) 2024; 16:3073. [PMID: 39272931 PMCID: PMC11394144 DOI: 10.3390/cancers16173073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/24/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024] Open
Abstract
Purpose: Conceptual models provide frameworks to illustrate relationships among patient-, provider-, system-, and community-level factors that inform care delivery and research. Existing models of cancer survivorship care focus largely on pediatric or adult populations whose needs differ from adolescents and young adults (AYAs). We developed a patient-centered conceptual model of AYA survivorship care. Methods: We conducted a narrative literature review of current conceptual and theoretical models of care. We engaged AYA cancer survivors (n = 25) in semi-structured one-hour telephone interviews. Most participants were in their 20s and 30s, and the majority (84%) were women. Recruitment was stratified by age and time since cancer diagnosis. We conducted a thematic analysis of interview transcripts to identify themes that exemplified patient-centered care. Results: Most participants identified as white and female. Leukemia and breast cancer were the most common cancer types. Main themes included the need for (1) care coordination, (2) ongoing mental health support, (3) connection to AYA peer support, (4) support during fertility preservation efforts, (5) support with financial burden, (6) support for quality of life, (7) information about and support with side effects and late effects, and (8) attention to the unique needs of young adults. Conclusions: We present a patient-centered conceptual model of AYA survivorship care needs that can inform future cancer care delivery and research.
Collapse
Affiliation(s)
- Marlaine S Figueroa Gray
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Lily Shapiro
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Sarah Randall
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | | | - Neetu Chawla
- Veterans Affairs Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer Street (152), North Hills, CA 91343, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109, USA
| | - Monica M Fujii
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, Pasadena, CA 91101, USA
| | - Theresa H M Keegan
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, 4501 X Street Suite 3016, Sacramento, CA 95817, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Office 4715, Salt Lake City, UT 84112, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Hazel B Nichols
- Gillings School of Global Public Health, University of North Carolina, 2104F Mcgavran-Greenberg Hall CB #7435, Chapel Hill, NC 27599, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| | - Candice A M Sauder
- Division of Surgical Oncology, Department of Surgery, University of California Davis Comprehensive Cancer Center, 4501 X Street Suite 3010, Sacramento, CA 95817, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Suite 1600, Seattle, WA 98101, USA
| |
Collapse
|
2
|
Rao P, Segel JE, Bingen K, Devine KA, Rumbaugh CL, Costigan HJ, Dandekar S, Wasserman E, Koehly LM, Blackall GF, Rakszawski K, Songdej N, Verdery AM, Lengerich EJ, Van Scoy LJ. Educational and occupational aspirations of adolescent and young adult cancer survivors: a qualitative analysis. Support Care Cancer 2024; 32:572. [PMID: 39105828 DOI: 10.1007/s00520-024-08761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Adolescent and young adult cancer survivors (AYACS) are patients diagnosed with cancer between 15 and 39 years of age. AYACS are often derailed from planned educational and occupational endeavors due to disruption from cancer treatment and its consequences. The study objective was to examine how a personal cancer diagnosis impacted AYACS' experiences related to these endeavors. METHODS Semi-structured interviews were conducted as part of a larger study assessing psychosocial challenges among a younger AYACS subset aged 15-25 years old at the time of cancer diagnosis. Interviews were coded based on responses and were used to develop themes related to educational and occupational endeavors. RESULTS Data were collected from 35 participants. Five themes emerged: (1) Pauses in educational attainment had a detrimental effect on educational goals for some participants, but further solidified and sculpted educational plans for others; (2) Although participants experienced challenges accomplishing educational goals, supportive school environments helped surmount these challenges; (3) Participants reflected on rethinking career aspirations, though some desired to pursue the same occupation planned before cancer diagnosis; (4) Participants experienced challenges, including physical and cognitive limitations, upon returning to work; and (5) Participants valued autonomy and normalcy through work and appreciated supportive and flexible work environments. CONCLUSIONS AYACS prioritize professional achievement, yet encounter challenges in achieving professional goals. Our findings create a foundation for developing and testing prospective interventions to promote continuance of school and work during cancer treatment when feasible, and proactive reintegration strategies for those who paused professional goals due to cancer treatment.
Collapse
Affiliation(s)
- Pooja Rao
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA, USA.
| | - Joel E Segel
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
- Penn State Cancer Institute, Hershey, PA, USA
| | - Kristin Bingen
- Division of Pediatric Psychology and Developmental Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | - Smita Dandekar
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA, USA
| | | | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - George F Blackall
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Penn State Health Children's Hospital, 500 University Drive, Hershey, PA, USA
| | | | | | - Ashton M Verdery
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, USA
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA, USA
| | | |
Collapse
|
3
|
Yusuf R, Ng DQ, Torno L, Chan A. Current evidence of integrative oncology modalities for managing adverse effects and survivorship issues among adolescents and young adult (AYA) cancer patients and survivors. Curr Opin Oncol 2024; 36:211-222. [PMID: 38842014 DOI: 10.1097/cco.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Symptom burden of cancer diagnosis and treatment has led adolescents and young adult cancer patients (AYAC) and survivors to seek different self-management strategies including integrative oncology (IO) modalities. IO holds great promise to improve survivorship issues in adolescents and young adult (AYA) cancer survivors. This review aims to encompass the current evidence of IO modalities and to analyze the efficacy of IO for managing survivorship issues among AYA cancer patients and survivors. RECENT FINDINGS Nineteen randomized controlled trials included in this review evaluated mind and body modalities including both physical and psychological (74%) and psychological only (26%) modalities. Most assessed IO modalities were physical activity (PA) (37%) and structured exercise (10%). Most effective IO modalities found were PA, massage, mindfulness-based stress reduction (MBSR) and light therapy for treating AYA symptom burden. The Cochrane risk of bias (RoB-2) concluded 21% studies had high risk, 58% possessed some concerns and 21% had low risk. SUMMARY Although evidence has shown that a number of IO modalities may improve survivorship among AYA cancer survivors, more rigorous study designs are needed in order for these modalities to be routinely recommended for use in clinical practice.
Collapse
Affiliation(s)
- Rukh Yusuf
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine
| | - Ding Quan Ng
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine
| | - Lilibeth Torno
- Division of Oncology, Children's Hospital of Orange County, Orange, USA
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine
| |
Collapse
|
4
|
Cho D, Roth M, Peterson SK, Jennings K, Kim S, Weathers SP, Ahmed S, Livingston JA, Barcenas C, You YN, Milbury K. Associations Between Stress, Health Behaviors, and Quality of Life in Young Couples During the Transition to Survivorship: Protocol for a Measurement Burst Study. JMIR Res Protoc 2024; 13:e53307. [PMID: 38652520 PMCID: PMC11077407 DOI: 10.2196/53307] [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: 10/09/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Cancer is a life-threatening, stressful event, particularly for young adults due to delays and disruptions in their developmental transitions. Cancer treatment can also cause adverse long-term effects, chronic conditions, psychological issues, and decreased quality of life (QoL) among young adults. Despite numerous health benefits of health behaviors (eg, physical activity, healthy eating, no smoking, no alcohol use, and quality sleep), young adult cancer survivors report poor health behavior profiles. Determining the associations of stress (either cancer-specific or day-to-day stress), health behaviors, and QoL as young adult survivors transition to survivorship is key to understanding and enhancing these survivors' health. It is also crucial to note that the effects of stress on health behaviors and QoL may manifest on a shorter time scale (eg, daily within-person level). Moreover, given that stress spills over into romantic relationships, it is important to identify the role of spouses or partners (hereafter partners) in these survivors' health behaviors and QoL. OBJECTIVE This study aims to investigate associations between stress, health behaviors, and QoL at both within- and between-person levels during the transition to survivorship in young adult cancer survivors and their partners, to identify the extent to which young adult survivors' and their partners' stress facilitates or hinders their own and each other's health behaviors and QoL. METHODS We aim to enroll 150 young adults (aged 25-39 years at the time of cancer diagnosis) who have recently completed cancer treatment, along with their partners. We will conduct a prospective longitudinal study using a measurement burst design. Participants (ie, survivors and their partners) will complete a daily web-based survey for 7 consecutive days (a "burst") 9 times over 2 years, with the bursts spaced 3 months apart. Participants will self-report their stress, health behaviors, and QoL. Additionally, participants will be asked to wear an accelerometer to assess their physical activity and sleep during the burst period. Finally, dietary intake (24-hour diet recalls) will be assessed during each burst via telephone by research staff. RESULTS Participant enrollment began in January 2022. Recruitment and data collection are expected to conclude by December 2024 and December 2026, respectively. CONCLUSIONS To the best of our knowledge, this will be the first study that determines the interdependence of health behaviors and QoL of young adult cancer survivors and their partners at both within- and between-person levels. This study is unique in its focus on the transition to cancer survivorship and its use of a measurement burst design. Results will guide the creation of a developmentally appropriate dyadic psychosocial or behavioral intervention that improves both young adult survivors' and their partners' health behaviors and QoL and potentially their physical health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53307.
Collapse
Affiliation(s)
- Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Seokhun Kim
- The Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School, Houston, TX, United States
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sairah Ahmed
- Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carlos Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Y Nancy You
- Department of Colon & Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
5
|
Sabri S, Mohamed Hussin NA, Chooi WT. Exploration of Hope Among Young Adults with Cancer in Malaysia. J Adolesc Young Adult Oncol 2024; 13:213-223. [PMID: 37389816 DOI: 10.1089/jayao.2023.0016] [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] [Indexed: 07/01/2023] Open
Abstract
Purpose: Hope is vital for cancer patients to cope with their illnesses. It is positively associated with better health outcomes, quality of life, and daily functioning. However, restoring hope after a cancer diagnosis can be challenging, especially for young adult cancer patients. This research aimed to investigate hope among young adults with cancer throughout their cancer experience and the exploration of hope preservation in these individuals. Methods: This qualitative study involved 14 young adults recruited from a closed Facebook group. The median age of the participants was 30.5 years (range 20-39 years), and their median survival year was 3 years (range 1-18 years from the date of diagnosis). Semistructured interviews and a thematic analysis were performed to identify the major themes that emerged from these interviews. Results: The findings identified that young adults expressed hopes for cancer advocacy, good physical and mental health, ease in the afterlife, and uncertain hopes due to thoughts of death. Three areas that influenced their hope are: (1) active hope with cancer peers; (2) cancer prognosis and hope; and (3) hope comes from prayer. Their cultural and religious beliefs influenced the various forms of hope and affected their experiences with cancer. In addition, this study discovered that not all positive communication with their physician resulted in hope. Conclusion: These findings provide important insight to health care professionals (HCPs) by encouraging young adults to discuss hope and improving the existing oncology social work-based intervention. This study suggests that hope is essential for chronic illness patients and should be supported continuously during and after treatments.
Collapse
Affiliation(s)
- Sahira Sabri
- School of Social Sciences, Social Work Section, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | | | - Weng-Tink Chooi
- School of Social Sciences, Social Work Section, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| |
Collapse
|
6
|
Burgers VWG, Reuvers MJP, Taphoorn MJB, Kok M, de Langen AJ, van den Bent MJ, Frissen SAMM, Harthoorn NCGL, Dickhout A, Husson O, van der Graaf WTA. A qualitative study on the healthcare experiences of adolescents and young adults (AYA) with an uncertain or poor cancer prognosis. Support Care Cancer 2023; 31:721. [PMID: 38008874 DOI: 10.1007/s00520-023-08149-9] [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: 04/24/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Treatment advancements have improved life expectancy for adolescents and young adults (AYAs) with an uncertain and/or poor cancer prognosis (UPCP) and change clinical practice. This improved survival requires a different approach and specific expertise to meet the needs of this group. The aim of this study is to explore the health care experiences of AYAs with a UPCP. METHODS We conducted a multicenter qualitative study using semi-structured interviews and elements of the grounded theory by Corbin and Strauss. RESULTS Interviews were conducted with 46 AYAs with a UPCP. They were on average 33.4 years old (age range 23-44), and most of them were woman (63%). Additionally, five AYAs with a UPCP participated as AYA research partners in two focus groups. They were on average 31.8 years old and four of them were woman. AYAs with a UPCP reported four pillars for a satisfied healthcare experience: (1) trust, (2) tailored communication, (3) holistic empathic open attitude, and (4) care being offered (pro-)actively. They reported both optimal and suboptimal experiences about distrust based on a delay in diagnostic trajectory, lack of tailored communication and discussion of sensitive topics, preference for a holistic approach, and struggles with finding the way to get additional healthcare support. CONCLUSION For AYAs with a UPCP, it is important that both age-specific issues and issues related to the UPCP are understood and addressed; however, this seems not yet optimally implemented in clinical practice. This emphasizes the importance of providing this patient group with tailored care incorporating both aspects. Healthcare professionals need to be supported with training and tools to understand the healthcare needs of AYAs with a UPCP. AYAs can be empowered to take more control over their own healthcare needs.
Collapse
Affiliation(s)
- Vivian W G Burgers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Milou J P Reuvers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Annemiek Dickhout
- AYA Research Partner, Amsterdam, the Netherlands
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW-School of Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Chan A, Ports K, Ng DQ, Nasr R, Hsu S, Armenian S, Baca N, Freyer DR, Kuo DJ, Lin C, Milam J, Valerin J, Yun C, Torno L. Unmet Needs, Barriers, and Facilitators for Conducting Adolescent and Young Adult Cancer Survivorship Research in Southern California: A Delphi Survey. J Adolesc Young Adult Oncol 2023; 12:765-772. [PMID: 36695742 DOI: 10.1089/jayao.2022.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction: An adolescent and young adult cancer (AYAC) patient is an individual who has received a cancer diagnosis between 15 and 39 years of age. They require significant survivorship care due to a combination of practical, physical, and mental health problems, but research in these areas is sparse. This study aimed to identify the unmet needs, barriers, and facilitators for conducting AYAC survivorship research in Southern California (SoCal) from the providers' and researchers' perspectives. Methods: A two-round, electronically administered Delphi survey study was conducted, involving a panel of 12 health care professionals and/or researchers with substantial work experience in AYAC. A 10-point Likert scale was used to evaluate 24 areas of unmet needs in AYAC survivors, 39 barriers, and 25 facilitators. Results: The top unmet needs in AYAC survivorship requiring research were in mental health issues, improving school/occupational performance, neurocognitive disorders, subsequent malignant neoplasms, and reproductive health. The top barriers identified were as follows: (1) institutions are too short-staffed to administer survivorship studies; (2) oncologists do not have the time/resources; and (3) lack of available funding. The top facilitators identified were as follows: (1) development of a mechanism/program to fund AYAC survivorship research studies; (2) in-person or virtual investigator engagement between children's hospitals and adult cancer centers to discuss research studies; and (3) developing personalized survivorship goals with AYAC patients and survivors to facilitate enrollment into survivorship studies. Conclusion: Experts identified the lack of time, manpower, funding, and resources as major barriers in AYAC survivorship research. Enhancing communication and collaboration with different stakeholders may facilitate AYAC survivorship research efforts within the SoCal region.
Collapse
Affiliation(s)
- Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
| | - Kayleen Ports
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
| | - Ding Quan Ng
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
| | - Reem Nasr
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
| | - Steffi Hsu
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
| | - Saro Armenian
- Department of Pediatrics, City of Hope, Duarte, California, USA
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Nicole Baca
- Department of Pediatric Hematology and Oncology, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California, USA
| | - David R Freyer
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | - Dennis John Kuo
- Division of Pediatric Hematology/Oncology, Rady Children's Hospital-San Diego, San Diego, California, USA
- Department of Pediatrics, University of California, San Diego, San Diego, California, USA
| | - Carol Lin
- Department of Pediatric Hematology/Oncology, Hyundai Cancer Institute at Children's Healthcare of Orange County, Orange, California, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Jennifer Valerin
- Division of Hematology/Oncology, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Christine Yun
- Department of Pediatric Hematology/Oncology, Hyundai Cancer Institute at Children's Healthcare of Orange County, Orange, California, USA
| | - Lilibeth Torno
- Department of Pediatric Hematology/Oncology, Hyundai Cancer Institute at Children's Healthcare of Orange County, Orange, California, USA
| |
Collapse
|
8
|
Lazard AJ, Meernik C, Collins MKR, Vereen RN, Benedict C, Valle CG, Love B. Social Media Use for Cancer Support Among Young Adults with Cancer. J Adolesc Young Adult Oncol 2023; 12:674-684. [PMID: 37257189 DOI: 10.1089/jayao.2023.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Purpose: Social media can facilitate peer support among young adults with cancer; however, information is needed about what social media are used, by whom, and how to inform resource and intervention recommendations. Methods: In December 2021, we conducted an online survey with 396 young adults with cancer, ages 18-39, with any diagnosis ages 15-39. Participants reported their social media use to connect with other young adults with cancer, including frequency of use, type of support, and affect (positive to negative) when using to connect with cancer peers. Results: Participants were on average 31 years old (SD = 5.2), with an average age of 27 at diagnosis (63.4% male, 62.1% non-Hispanic White). Almost all (97.5%) reported using social media to connect with other young adults with cancer. Many (48.0%) used three or more social media platforms for cancer support, including Facebook (44.4%), YouTube (43.6%), Instagram (43.4%), Snapchat (36.9%), and Twitter (36.9%). Daily use for cancer support was common (32.9%-60.9%) among those who used social media, particularly among those who were younger; are not transgender; live in urban areas; or had brain, gynecologic, or testicular cancers. Across social media platforms, young adults with cancer reported seeking and sharing emotional support (88.9%), informational support (84.1%), and making connections (81.3%). Conclusion: Young adults with cancer use social media to connect with cancer peers for support. Commonly used existing social media (e.g., Facebook, YouTube, Instagram) should be prioritized in interventions to reach young adults who desire more age-appropriate resources to improve their psychosocial health.
Collapse
Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Clare Meernik
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Meredith K Reffner Collins
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rhyan N Vereen
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine Benedict
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Carmina G Valle
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brad Love
- Center for Health Communication, The University of Texas, Austin, Texas, USA
- GRYT Health, Rochester, New York, USA
| |
Collapse
|
9
|
Testoni I, Nicoletti AE, Moscato M, De Vincenzo C. A Qualitative Analysis of the Experiences of Young Patients and Caregivers Confronting Pediatric and Adolescent Oncology Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6327. [PMID: 37510561 PMCID: PMC10378996 DOI: 10.3390/ijerph20146327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Epidemiological studies show that new cases of young oncology patients are increasing by 400,000 every year. Psychological literature has shown that receiving an oncological diagnosis can cause significant psychological stress and discomfort. However, the experiences of young patients and their caregivers as they confront this challenge are not yet fully understood. This paper adopts a qualitative methodological approach to explore how young patients with an oncological diagnosis and their parents make sense of the experiential challenges they face. Thus, the research realized 18 semi-structured interviews, 11 of which were with pediatric and adolescent oncology patients, and 7 of which were with 6 mothers and 1 father. The qualitative thematic analysis revealed that the oncological diagnosis triggers different emotions taking the scene in the attempt to cope with the threats of meaning that the diagnosis poses. However, such intense experience promotes transformative feelings in parents and young patients, leading to important personal growth. Lastly, this article discusses the need to improve palliative psychological care competences in pediatric oncology. By providing comprehensive psychological care to young oncology patients and their families, healthcare providers can mitigate the psychological stress and pain associated with the diagnosis and treatment of cancer.
Collapse
Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, 35131 Padua, Italy
- Sagol Creative Arts Therapies Research Center, Haifa 31905, Israel
| | | | - Matilde Moscato
- Sagol Creative Arts Therapies Research Center, Haifa 31905, Israel
| | - Ciro De Vincenzo
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, 35131 Padua, Italy
| |
Collapse
|
10
|
Wu VS, Benedict C, Friedman DN, Watson SE, Anglade E, Zeitler MS, Chino F, Thom B. Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors? Support Care Cancer 2023; 31:434. [PMID: 37395811 DOI: 10.1007/s00520-023-07822-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE This study aims to evaluate the associations between patient-provider cost discussions with patient-reported out-of-pocket (OOP) spending and long-term financial toxicity (FT) among adolescent and young adult (AYA; 15-39 years old) cancer survivors. METHODS Using a cross-sectional survey, we assessed the themes and quality of patient discussions with providers about financial needs and general survivorship preparation, quantified patients' levels of FT, and evaluated patient-reported OOP spending. We determined the association between cancer treatment cost discussion and FT using multivariable analysis. In a subset of survivors (n = 18), we conducted qualitative interviews and used thematic analysis to characterize responses. RESULTS Two hundred forty-seven AYA survivors completed the survey at a mean of 7 years post treatment and with a median COST score of 13. 70% of AYA survivors did not recall having any cost discussion about their cancer treatment with a provider. Having any cost discussion with a provider was associated with decreased FT (β = 3.00; p = 0.02) but not associated with reduced OOP spending (χ2 = 3.77; p = 0.44). In a second adjusted model, with OOP spending included as a covariate, OOP spending was a significant predictor of FT (β = - 1.40; p = 0.002). Key qualitative themes included survivors' frustration about the lack of communication related to financial issues throughout treatment and in survivorship, feeling unprepared, and reluctance to seek help. CONCLUSION AYA patients are not fully informed about the costs of cancer care and FT; the dearth of cost discussions between patients and providers may represent a missed opportunity to reduce costs.
Collapse
Affiliation(s)
- Victoria S Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| |
Collapse
|
11
|
Hayek S, Libresco G, Barda N, Chao C, Xu L, Cannavale KL, Izraeli S, Armenian SH. Chronic health conditions among long-term survivors of adolescent and young adult (AYA) cancer: A comparison of outcomes in Israel and the United States. Cancer 2023; 129:1763-1776. [PMID: 36929478 DOI: 10.1002/cncr.34740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is a paucity of information on health outcomes of adolescent and young adult (AYA) cancer survivors living outside North America and Europe. This study compared outcomes in AYA cancer survivors in Israel with individuals without cancer and similar demographics and access to health care, and to AYA cancer survivors living in the United States. METHODS This study included 12,674 2-year survivors of AYA (aged 15-39 years) cancer diagnosed between 2000 and 2018 at Clalit Health Services (CHS) in Israel. CHS participants without cancer (N = 50,696) were matched 4:1 to survivors on age, sex, ethnicity, and membership duration. Poisson regression was used to determine incidence rate ratios (IRRs) for chronic conditions. The US Kaiser Permanente Southern California AYA cohort (N = 6778) was used to estimate weighted (age, sex) standardized incidence ratios (SIRs) for CHS survivors. RESULTS CHS AYA cancer survivors were more likely to have any chronic condition (IRR, 1.6 95% CI, 1.5-1.7), compared with participants without cancer. Survivors had an increased risk across nearly all conditions examined, with especially elevated risks for osteoporosis (IRR, 4.7; 95% CI, 4.1-5.5) and cardiomyopathy (IRR, 4.2 95% CI, 3.4-5.3). Compared with the Kaiser Permanente Southern California cohort, CHS survivors had an overall lower (SIR, 0.68; 95% CI, 0.65-0.72) incidence of developing any health condition, with noticeably lower incidence of hyperlipidemia (SIR, 0.7; 95% CI, 0.64-0.75). CONCLUSION AYA cancer survivors in Israel are at increased risk for developing chronic conditions compared with individuals without cancer, but the overall incidence was lower than in US survivors. These findings may allow for refinement of surveillance recommendations for AYA survivors, taking into consideration regional differences in sociodemographic characteristics and cancer care. PLAIN LANGUAGE SUMMARY The burden of chronic conditions was consistently greater in Israeli adolescent and young adult cancer survivors compared with individuals without cancer, with clear differences in risk of specific conditions by cancer diagnosis. However, the overall incidence of chronic conditions in Israeli survivors was generally lower than in US survivors.
Collapse
Affiliation(s)
- Samah Hayek
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel.,Department of Epidemiology, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Libresco
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel.,Software and Information Systems Engineering, Ben-Gurion University, Be'er Sheva, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Chun Chao
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting, Solon, Ohio, USA
| | | | - Shai Izraeli
- Division of Pediatric Hematology, Oncology, Schneider Children's Medical Center, Tel-Aviv, Israel.,Department of Molecular Genetics and Biochemistry, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Systems Biology, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California, USA.,Department of Pediatrics, City of Hope, Duarte, California, USA
| |
Collapse
|
12
|
Boone AN, Arbuckle JL, Ye Y, Wolfson JA. How Accurate Is Oncologist Knowledge of Fertility Preservation Options, Cost, and Time in Female Adolescents and Young Adults? J Adolesc Young Adult Oncol 2023; 12:110-117. [PMID: 35447034 DOI: 10.1089/jayao.2021.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Often cited barriers to fertility preservation (FP) among female adolescent and young adult (AYA) cancer patients include cost and time. We hypothesized that oncologists overestimate the time and costs required for female FP. Methods: We distributed an electronic survey to physicians in oncology-related departments. The survey assessed the knowledge and utilization of gonadotoxic therapies, FP options and requirements, and FP referral patterns. Student's t, Fisher's exact, ANOVA, and Wilcoxon signed-rank tests were used for continuous variables as appropriate; the chi-squared test was used for categorical variables. Results: Among respondents who reported prescribing gonadotoxic agents to AYAs (n = 38), 79% reported often/always discussing FP options, while only half referred to a reproductive specialist often/always. A smaller proportion of pediatric oncologists discussed FP often/always (p = 0.04) and most referred <25% of patients to a reproductive specialist; however, the majority of other specialists referred ≥75% of patients to a reproductive specialist (p = 0.001). While most respondents accurately estimated the time required to complete FP, the majority overestimated the cost of an FP procedure. Knowledge of FP options was inconsistent, with 63.2% reporting that suppression of the hypothalamic-pituitary-ovarian-axis is an option for FP, with 82.6% of these classifying it as standard of care. Conclusions: With variation across specialties, most oncology specialists prescribing gonadotoxic therapies for AYA females discuss FP, while a smaller proportion refer patients for FP. Despite relative accuracy in estimating the time required for FP, they overestimate costs of FP. Educational curricula related to FP are necessary across oncology specialties, especially pediatric oncology.
Collapse
Affiliation(s)
- Amy N Boone
- Division of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janeen L Arbuckle
- Division of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuanfan Ye
- Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julie A Wolfson
- Division of Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
13
|
Moraitis AM, Seven M, Sirard J, Walker RR. Clinical Relevance and Implementation Considerations of Physical Activity in Young Adult Cancer Survivorship: An Expert Consensus Study. J Adolesc Young Adult Oncol 2022. [PMID: 36269579 DOI: 10.1089/jayao.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Elevated survival rates in young adult cancer survivors (YACS) are accompanied by high morbidity levels resulting in an array of unmet needs limiting full life potential. Physical activity (PA) improves physical, psychological, and social aspects of health after a cancer diagnosis. There are no standardized PA guidelines tailored to YACS. Therefore, there is a critical need to understand areas of clinical relevance/agreement on PA use and implementation in young adult (YA) survivorship care. Aim: To identify expert consensus areas on the assessment, prescription, and implementation of PA in YA survivorship care; identify areas of clinical relevance and endorsement of PA as a health optimization strategy in YA survivorship care. Methods: A four-round modified Delphi study of international multidisciplinary experts (Round I/II n = 18; Round III n = 57, Round IV n = 45) in exercise oncology, symptom management, survivorship care, youth cancer care was conducted. Qualitative content analysis, descriptive statistics (% agreement, standard deviation, mean), and inter-rater reliability (Kappa) were calculated. Results: Experts reached a consensus on clinical providers needed to assess, refer, and provide PA interventions, the need for guidelines, and essential care delivery system components to foster the integration of PA integration in YA survivorship care as a health optimization activity. Conclusions/Implications: Cancer care integration models should optimize the unique preferences, strengths, and developmental stage of YA affected by cancer. The study adds to the existing literature on multidisciplinary teams needed to provide clinical expertise and organizational support to foster PA integration into YA survivorship care.
Collapse
Affiliation(s)
| | - Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - John Sirard
- Department of Kinesiology and Commonwealth Honors College, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| | - Rachel Rae Walker
- Elaine Marieb College of Nursing, University of Massachusetts, Amherst, Massachusetts, Amherst, USA
| |
Collapse
|
14
|
Hess E, Anandan A, Osman F, Lee-Miller C, Parkes A. Disparities in Treatment Satisfaction and Supportive Care Receipt for Young Adult Oncology Patients on the Basis of Residential Location. JCO Oncol Pract 2022; 18:e1542-e1552. [DOI: 10.1200/op.21.00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Adolescent and young adult oncology programs are critical but exist primarily in academic centers, prompting potential disparities in care on the basis of patient residence. We studied the impact of residential location on supportive care receipt and treatment satisfaction in young adults (YAs) with cancer age 19-39 years treated at the University of Wisconsin Carbone Cancer Center (UWCCC). METHODS: YA patients with cancer age 19-39 years seen at UWCCC from March 30, 2019, to March 29, 2020, were sent a survey assessing supportive care receipt and satisfaction. Survey results were compared with retrospective chart review of YAs seen at UWCCC between April 1, 2011, and April 1, 2021. Data were categorized on the basis of residential location using distance from UWCCC and 2013 Rural-Urban Continuum Code (RUCC). RESULTS: Survey results were obtained for 145 YAs, including 29 from nonmetro RUCC (20.0%) and 81 living > 20 miles from UWCCC (55.9%). YAs from nonmetro locations had lower satisfaction with available treatments (79.3% v 91.4%, P = .005), and distant YAs living > 20 miles from UWCCC more frequently identified location as a barrier to supportive care receipt (35.6% v 15.8%, P = .02). Metro YAs more frequently listed fertility consultations as unavailable (38.0% v 16.0%, P = .04) in the survey despite chart review data showing higher rates of sexual health assessments (48.2% v 20.4%, P = .002) and fertility visits (29.6% v 18.5%, P = .18). CONCLUSION: We identified differences in both supportive care receipt and treatment satisfaction on the basis of residential location. These findings support the need for measures to successfully meet treatment and supportive care needs regardless of residential location.
Collapse
Affiliation(s)
- Eric Hess
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Apoorva Anandan
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Fauzia Osman
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Cathy Lee-Miller
- University of Wisconsin-Madison School of Medicine and Public Health Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Madison, WI
| | - Amanda Parkes
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| |
Collapse
|
15
|
Pyke-Grimm KA, Franck LS, Halpern-Felsher B, Goldsby RE, Rehm RS. Day-to-Day Decision Making by Adolescents and Young Adults with Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:290-303. [PMID: 35538622 PMCID: PMC9807778 DOI: 10.1177/27527530211068718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.
Collapse
Affiliation(s)
- Kimberly A. Pyke-Grimm
- Stanford Children's Health, Department of Nursing Research and
Evidence-Based Practice, Palo Alto, CA, USA,Division of Hematology/Oncology, Department of Pediatrics, Stanford
University School of Medicine,Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA,Kimberly A. Pyke-Grimm, PhD, RN, CNS,
CPHON, Department of Nursing Research and Evidence-Based Practice, Stanford
Children's Health, 750 Welch Road, Palo Alto, CA 94304, USA.
| | - Linda S. Franck
- Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | | | - Roberta S. Rehm
- Department of Family Health Care Nursing, San Francisco School of
Nursing, University of California, San Francisco, CA, USA,*Professor Emeritus
| |
Collapse
|
16
|
Bood ZM, van Liemt F, Sprangers MAG, Kobes A, Weeseman Y, Scherer-Rath M, Tromp JM, van Laarhoven HWM, Helmich E. This is what life with cancer looks like: exploring experiences of adolescent and young adults with cancer using two visual approaches. Support Care Cancer 2022; 30:3353-3361. [PMID: 34988705 PMCID: PMC8730754 DOI: 10.1007/s00520-021-06775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/18/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Talking about illness experience can be challenging for adolescents and young adults (AYAs) with cancer. Visual tools, in addition to spoken language, might make this easier, such as rich pictures and photovoice. We aimed to obtain a comprehensive view of the cancer experience of AYAs by using rich pictures and photovoice. METHODS AYAs (18-35 years old) who had any type of cancer, or were in remission from cancer, were eligible. AYAs drew rich pictures about their experience of living with cancer and explained these during subsequent interviews. Some of the AYAs also participated in photovoice and spent two days with a photographer to make photos about their illness experience. Rich pictures and photos were first analyzed separately, using open coding, after which the identified themes were compared. RESULTS Twelve AYAs made rich pictures (RPs), of whom seven also participated in photovoice. The two most predominant themes emerging from the data were struggles related to the future and defining one's identity. The AYAs expressed concerns for the future related to relationships, education, and employment. Relating to defining one's identity, many AYAs expressed that the cancer had a negative impact on their body- and self-image. The main themes were visible in the RPs as well as in the photovoice; however, subtle differences in sub-themes were found. CONCLUSIONS We found that cancer has an effect on many aspects of AYAs' lives. Further research on how the identified themes play a role in the lives of AYAs with cancer is needed.
Collapse
Affiliation(s)
- Zarah M Bood
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Annita Kobes
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Yvonne Weeseman
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michael Scherer-Rath
- Faculty of Philosophy, Theology, and Religious Studies, Radboud University-Nijmegen, Nijmegen, The Netherlands
| | - Jacqueline M Tromp
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Esther Helmich
- Amsta Healthcare Organisation, Amsterdam, the Netherlands
| |
Collapse
|
17
|
Bronk KC, Giesemann X, Donaldson R, Mitchell C. Understanding how a cancer diagnosis can shape young people’s views of the future and their purpose in life. APPLIED DEVELOPMENTAL SCIENCE 2022. [DOI: 10.1080/10888691.2022.2026774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
18
|
Broholm-Jørgensen M, Tjørnhøj-Thomsen T, Pedersen PV. Development of an intervention for the social reintegration of adolescents and young adults affected by cancer. BMC Public Health 2022; 22:241. [PMID: 35123447 PMCID: PMC8818212 DOI: 10.1186/s12889-022-12611-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Background In Denmark, around 500 adolescents and young adults (AYAs) aged 15–29 are diagnosed with cancer each year. AYAs affected by cancer constitute a vulnerable group in need of special support in pursuing everyday life as young people. These needs are, however, not currently being adequately met. This study explores the distinctive needs of AYAs aged 15–25 and affected by cancer with the aim of developing and designing an intervention that accommodates these needs and allows AYAs to pursue everyday life following active cancer treatment. Methods We combined multiple qualitative methods to conduct six sub-studies: 1) participant observation among support groups for AYAs affected by cancer, 2) field visit at a large Danish hospital, 3) qualitative interviews with AYAs currently or previously diagnosed with cancer, 4) qualitative interviews with practitioners working with young cancer patients or AYAs with chronic conditions, 5) an interactive workshop with practitioners, and 6) an interactive workshop with AYAs. The empirical material was collected between May 2016 and April 2019. The empirical material was read, analysed thematically and coded into the themes; 1) diagnosis and treatment, 2) form of education and 3) age, financial challenges and legal entitlements. Results Across the empirical material, we found that AYAs’ cancer experience was heterogeneous. The needs of AYAs differed according to 1) diagnosis and treatment, 2) type of education and 3) age, financial situation and legal entitlements. The findings demonstrate a need for a tailored intervention accommodating the variety of opportunities, requirements and challenges of AYAs with cancer. We propose an intervention consisting of a multidisciplinary team sited at the hospital where the individual AYA receives treatment. The team’s main task will be to maintain AYAs’ social competences and ease their return to everyday life after serious illness by balancing educational requirements with cancer treatment. Conclusion Based on the perspectives of practitioners and AYAs affected by cancer, this study outlines an intervention designed as a care pathway in which a multidisciplinary team provides individual and tailored support to AYAs with cancer from the time of diagnosis during and beyond active cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12611-4.
Collapse
|
19
|
The Role of Financial Security on Physical and Mental Health in Young-Midlife Couples Surviving Cancer. Cancer Nurs 2022; 45:242-248. [DOI: 10.1097/ncc.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Abdelhadi OA, Pollock BH, Joseph JG, Keegan THM. Psychological distress and associated additional medical expenditures in adolescent and young adult cancer survivors. Cancer 2022; 128:1523-1531. [PMID: 35001391 DOI: 10.1002/cncr.34064] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/19/2021] [Accepted: 11/13/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer survivors experience psychological distress often because of cancer and its treatment. However, no prior studies have evaluated the additional medical expenditures and health care utilization associated with psychological distress in AYA cancer survivors. METHODS AYA cancer survivors and a comparison matched group of adults with no history of cancer were identified from 2011-2016 Medical Expenditure Panel Survey data. Medical expenditures and health care utilization were evaluated with multivariable regression models. RESULTS AYA cancer survivors were more likely to have psychological distress (11.5% of 1757) than adults with no history of cancer (5.8% of 5227). The prevalence of psychological distress was found to be high many years after the diagnosis, with 11.2% reporting distress ≥20 years after their cancer diagnosis. AYA cancer survivors with psychological distress were more likely to smoke and have chronic conditions and were less likely to exercise regularly in comparison with AYAs with no history of psychological distress. AYA cancer survivors with psychological distress had additional annual medical expenses ($4415; 95% CI, $993-$9690), office visits (2.80; 95% CI, 0.23-6.15), and use of prescription medications/medication renewals (11.58; 95% CI, 5.70-19.47) in comparison with AYA cancer survivors without psychological distress. Additional annual medical expenses of psychological distress were $2600 higher in AYA cancer survivors than adults without a history of cancer ($1802; 95% CI, $440-$3791). CONCLUSIONS These results highlight the substantial economic burden associated with psychological distress in AYA cancer survivors. This research could inform survivorship care plans and interventions addressing the psychological needs of AYA cancer survivors.
Collapse
Affiliation(s)
- Ola A Abdelhadi
- Graduate Group of Epidemiology, University of California Davis, Davis, California
| | - Brad H Pollock
- Graduate Group of Epidemiology, University of California Davis, Davis, California.,Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
| | - Theresa H M Keegan
- Graduate Group of Epidemiology, University of California Davis, Davis, California.,Department of Public Health Sciences, University of California Davis, Sacramento, California.,Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| |
Collapse
|
21
|
"Now everybody is thinking about things like that.": Young Adult Cancer Survivors Reimagining Work During the COVID-19 Pandemic. Nurs Res 2021; 71:153-157. [PMID: 34818265 DOI: 10.1097/nnr.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diagnosed between ages 20-39, young adult (YA) cancer survivors have faced disruption to their lives well before the COVID-19 pandemic. Often seen as an at-risk population within cancer survivors, YAs experience the demands of a serious illness, such as cancer, alongside meeting the typical milestones of young adulthood and often have worse quality of life than their non-cancer peers. There is a need to further study the effect of the COVID-19 pandemic on specific populations, including YA cancer survivors (YACS), as it relates to work. OBJECTIVES Explore working YACS' experiences during the COVID-19 pandemic and identify facets of cancer survivorship that researchers can use to explore COVID-19 survivorship further. METHODS Secondary thematic analysis of 40 semistructured, qualitative interviews conducted through Zoom audio during the COVID-19 pandemic. YA hematologic cancer survivors were recruited through social media; they were eligible if they had completed active therapy, were within 5 years of their diagnosis, and working at the time of diagnosis. Interviews were transcribed verbatim and subjected to thematic content analysis. RESULTS Themes surrounded COVID's influence on working YACS' experiences, with the overarching theme: "From solo to shared experience: A change in awareness and understanding." A subtheme was "Lesson reaffirmed: Reimagining the work environment." DISCUSSION The consequences of COVID-19 on the overall quality of life for YACS are multilevel. Establishing the evidence for effective interventions to support YACS in the workplace, whether physical or virtual, is critically needed. Research is needed on YACS' risk and resilience factors that could ultimately impact future health and quality of life.
Collapse
|
22
|
Munsie C, Ebert J, Collins J, Plaster M, Joske D, Ackland T. A supervised exercise intervention during cancer treatment for adolescents and young adults-FiGHTING F!T: study protocol of a randomised controlled trial. Trials 2021; 22:676. [PMID: 34602065 PMCID: PMC8489079 DOI: 10.1186/s13063-021-05616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND High-quality evidence supports the integration of exercise to mitigate treatment-related side effects in a wide range of paediatric and adult cancer cohorts. However, the implementation of exercise in adolescent and young adult (AYA) cancer patients is yet to be explored in depth. FiGHTINGF!T is a randomised controlled cross over trial designed to determine if a supervised, structured, and progressive exercise programme can reduce the decline in physical fitness (V02peak) associated with cancer treatment in AYAs from diagnosis. METHODS/DESIGN A total of 40 AYAs recently diagnosed and due to commence systemic treatment (± 2 weeks) for a primary haematological malignancy or solid tumour will be recruited and randomised to either an immediate exercise intervention or usual care (delayed exercise) for 10 weeks. This randomised controlled crossover trial will see both groups engage in a supervised exercise intervention from either diagnosis (baseline assessment) for 10 weeks (0-10 weeks) or following an interim assessment to 20 weeks (10-20 weeks). The bi-weekly tailored exercise programme will combine aerobic and resistance exercises and be supervised by an Accredited Exercise Physiologist. Participants will complete a range of assessments at 0, 10, and 20 weeks including cardiopulmonary exercise tests, 1 repetition maximum strength measures, physical functioning, and self-reported quality of life measurements. Patient-reported treatment-related toxicities will be recorded on a weekly basis. DISCUSSION The FiGHTINGF!T trial will provide insight into the potential benefits of a supervised exercise programme in AYAs undergoing cancer treatment. This trial will contribute to the evidence supporting the necessary integration of exercise during cancer treatment, specifically in the under-reported AYA cohort. TRIAL REGISTRATION This trial was registered retrospectively with the Australia New Zealand Clinical Trial registry ( ACTRN12620000663954 ). Registered on 10 June 2020.
Collapse
Affiliation(s)
- Claire Munsie
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Jay Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
| | - Joanne Collins
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - Megan Plaster
- Western Australian Youth Cancer Service, Perth, Western Australia Australia
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - David Joske
- Sir Charles Gairdner Hospital, Perth, Western Australia Australia
- School of Medicine, University of Western Australia, Western Australia Perth, Australia
| | - Timothy Ackland
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia Australia
| |
Collapse
|
23
|
Lazard AJ, Collins MKR, Hedrick A, Varma T, Love B, Valle CG, Brooks E, Benedict C. Using Social Media for Peer-to-Peer Cancer Support: Interviews With Young Adults With Cancer. JMIR Cancer 2021; 7:e28234. [PMID: 34473063 PMCID: PMC8446843 DOI: 10.2196/28234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 07/11/2021] [Indexed: 01/19/2023] Open
Abstract
Background Web-based social support can address social isolation and unmet support needs among young adults with cancer (aged 18-39 years). Given that 94% of young adults own and use smartphones, social media can offer personalized, accessible social support among peers with cancer. Objective This study aims to examine the specific benefits, downsides, and topics of social support via social media among young adults with cancer. Methods We conducted semistructured interviews with young adults with cancer, aged between 18 and 39 years, who were receiving treatment or had completed treatment for cancer. Results Most participants (N=45) used general audience platforms (eg, Facebook groups), and some cancer-specific social media (eg, Caring Bridge), to discuss relevant lived experiences for medical information (managing side effects and treatment uncertainty) and navigating life with cancer (parenting and financial issues). Participants valued socializing with other young adults with cancer, making connections outside their personal networks, and being able to validate their emotional and mental health experiences without time and physical constraints. However, using social media for peer support can be an emotional burden, especially when others post disheartening or harassing content, and can heighten privacy concerns, especially when navigating cancer-related stigma. Conclusions Social media allows young adults to connect with peers to share and feel validated about their treatment and life concerns. However, barriers exist for receiving support from social media; these could be reduced through content moderation and developing more customizable, potentially cancer-specific social media apps and platforms to enhance one’s ability to find peers and manage groups.
Collapse
Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Meredith K Reffner Collins
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ashley Hedrick
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tushar Varma
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brad Love
- School of Advertising and Public Relations, The University of Texas at Austin, Austin, TX, United States.,Gryt Health, New York, NY, United States
| | - Carmina G Valle
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erik Brooks
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | |
Collapse
|
24
|
Lidington E, Vlooswijk C, Stallard K, Travis E, Younger E, Edwards P, Nandhabalan M, Hunter N, Sarpal N, Flett D, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Darlington AS, Gonzalez M, Sirohi B, van der Graaf WTA, Husson O. 'This is not part of my life plan': A qualitative study on the psychosocial experiences and practical challenges in young adults with cancer age 25 to 39 years at diagnosis. Eur J Cancer Care (Engl) 2021; 30:e13458. [PMID: 33942418 DOI: 10.1111/ecc.13458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adolescents and young adults with cancer face unique psychosocial and practical issues. However, patients across this group encounter different life experiences, cancer diagnoses and treatment settings given the tailored services for patients ages 15 to 24. Here, we qualitatively explore the psychosocial experiences and practical challenges of young adults (YAs) with cancer diagnosed between ages 25 and 39 in the United Kingdom. METHODS We invited YAs diagnosed with cancer in the 5 years prior to enrolment at participating sites to take part in semi-structured interviews or focus groups. Transcripts were analysed using inductive thematic analysis. Two YA patients reviewed the results to ensure robustness. RESULTS Sixty-five YAs with varied diagnoses participated. Participants struggled to balance work, childcare and financial solvency with treatment. The halt in family and work life as well as changes in image and ability threatened participants' identity and perceived 'normality' as a YA, however, these also stimulated positive changes. YAs experienced social isolation from friends and family, including children. Many struggled to cope with uncertainty around treatment outcomes and disease recurrence. CONCLUSION The disruption of family and work life can lead to age-specific issues in YAs diagnosed with cancer. Age-tailored psychological and practical services must be considered.
Collapse
Affiliation(s)
| | - Carla Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Amy Din
- University of Southampton, Southampton, UK
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - James Larkin
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | | | | | - Susana Banerjee
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Zoltan Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | | | - Bhawna Sirohi
- Barts Health NHS Trust, London, UK
- Apollo Proton Cancer Centre, Chennai, India
| | | | - Olga Husson
- Institute of Cancer Research, London, UK
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| |
Collapse
|
25
|
Experiences of living with cancer of adolescents and young adults and their families: A narrative review and synthesis. ENFERMERÍA CLÍNICA (ENGLISH EDITION) 2021; 31:234-246. [PMID: 34243911 DOI: 10.1016/j.enfcle.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Adolescence is a critical life stage marked by significant physical, psychological, and social change. Cancer diagnosis during adolescence profoundly affects this experience for adolescents and young adults (AYA) and their families with an impact that continues throughout life. It is important to understand these experiences to ensure delivery of appropriate and high-quality supportive care. This narrative review critically appraised and synthesised qualitative literature that explored the experiences of AYAs and their families living with cancer. METHOD Narrative review and synthesis of qualitative research of AYAs' and their families' experiences of cancer. MEDLINE, CINAHL and PsycINFO were searched between February 2000 and September 2019 using search terms including "adolescent", "young people", "young adult", "cancer", "family", and "qualitative". Literature was appraised and synthesised using Popay et al.'s1 framework. RESULTS 3016 articles were retrieved (Medline n=1298, CINAHL n=1632, PsycINFO n=86). Of these, 151 duplicates were removed. 2865 papers were screened with 121 abstracts considered for eligibility for inclusion. Eighteen papers met the inclusion criteria. Three inter-related themes were identified: being diagnosed with cancer; uncertainty - holding on to life and gaps in care delivery. DISCUSSION AND RECOMMENDATIONS Few studies discuss the impact of cancer on the families of AYA living with cancer. Future research should explore this experience. By doing so the relational impact of cancer will be better understood as the basis of supportive family-centred care. PROSPERO Registration: CRD42017084148.
Collapse
|
26
|
McInally W, Gray-Brunton C, Chouliara Z, Kyle RG. Life Interrupted: Experiences of adolescents, young adults and their family living with malignant melanoma. J Adv Nurs 2021; 77:3867-3879. [PMID: 34245464 DOI: 10.1111/jan.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
AIM Melanoma is one of the most common human malignancies; yet, it is often thought of as a disease of adulthood rather than one affecting adolescents and young adults. This study sought to understand the experiences of adolescents, young adults and their family living with malignant melanoma. DESIGN A qualitative study using Interpretive Phenomenological Analysis, through a multi-perspective design. METHODS Data collection was conducted between January and August 2018 in each participant's Primary Care Centre when they were attending for an outpatient appointment. Each young person and a nominated family member were interviewed (n = 10) either individually (n = 4) or as a dyad (n = 6) according to their personal choice. In-depth semi-structured interviews were conducted and audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed. FINDINGS The metanarrative 'Life Interrupted' was the core conceptual thread woven throughout the findings. It represents the interconnections and interrelationships between the adolescent or young adult and their family. Being able to recognize the disease and seek support was challenging with often limited physical, emotional or social support resulting in feelings of fear and isolation. Four super-ordinate themes were identified: (a) 'Is it Serious', (b) 'Too Much too Young', (c) 'Not the Same' and (d) 'Time to Live'. CONCLUSIONS With the rising incidence of MM in the adolescents and young adults population globally, there are demands to improve healthcare professionals and nurse's knowledge and understanding of MM. As young people with MM experience their journey outside specialist cancer services, the care delivery for this patient group and their families require stronger links between services. IMPACT This study will inform the improvement of care delivery for MM in order that this patient group is provided with the same access to service delivery as other adolescents and young adults with cancer.
Collapse
Affiliation(s)
| | | | - Zoe Chouliara
- Senior Practitioner, Counselling & Psychologist Edinburgh
| | - Richard G Kyle
- Research and Evaluation Division, Public Health Wales, Cardiff, UK
| |
Collapse
|
27
|
Alander MEJ, Klaeson K, Nyqvist H, Olausson S. Lived experiences and caring needs in young adults diagnosed with cancer. Nurs Forum 2021; 56:781-790. [PMID: 33993486 DOI: 10.1111/nuf.12595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/23/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the lived experience of young adults diagnosed with cancer and to increase our understanding of how to help them with their caring needs. BACKGROUND Being diagnosed with cancer is normally related with an existential crisis. This indicates that the individual cannot avoid thoughts of death, loneliness, guilt, and meaninglessness. In person-centered care, the caretaker should have a holistic view of the person. Professionals must meet the patient´s different needs to strengthen health and well-being for the diagnosed. This approach encourages the traditionally passive patient to become an active consumer who works in partnership with the healthcare provider. DESIGN For this study, a content analysis of narratives was conducted, targeting age groups of 20-29 to take part of young adults' experiences. METHODS Qualitative analysis of narratives and followed checklist (e.g., COREQ). RESULTS During the analyzing phase, two main themes emerged: Interactions with Professionals and Cancer Voyager. In the results, both positive and negative feelings regarding encounters and support received from the professionals were described, this affected the young adults' well-being and their ability to participate during treatments. The young adults felt as being on a journey with no control over which direction the road may take. CONCLUSION Outcome of the result shows the importance of making the young adult, one in a team. When working in a person-centered way, patients gain control by owning their own responsibility during treatments. IMPLICATIONS FOR NURSING PRACTICE There is a need in nursing education to address existential matters, to make nursing students ready to be approach but such questions in their professional work. Also, we believe that the experienced nurse must be given means to feel confident to handle questions about existential matters. By developing skills in the area of e-Health, collaboration through support groups, and last but not least switching to patient-centered care, we can offer effective and evidence-based care tailored for this population.
Collapse
Affiliation(s)
| | - Kicki Klaeson
- Department of Health Sciences, Högskolan i Skövde, Skövde, Sweden.,Department of Oncology, Skaraborgs Hospital, Lidköping, Sweden
| | | | | |
Collapse
|
28
|
Additional medical costs of chronic conditions among adolescent and young adult cancer survivors. J Cancer Surviv 2021; 16:487-496. [PMID: 33899161 DOI: 10.1007/s11764-021-01044-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/13/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Adolescent and young adult (AYA) cancer survivors are more likely to have multiple chronic conditions compared to AYAs without history of cancer. The financial hardship of chronic conditions associated with cancer can substantially impact cancer survivors. We aim to assess health risk behaviors and health care access factors associated with increased medical expenses in AYA cancer survivors. METHODS We utilized 2011-2016 Medical Expenditure Panel Survey (MEPS) data to identify the prevalence of chronic conditions, health risk behaviors, and health care access in 2326 AYA cancer survivors. The association between health risk behaviors, health care access factors, and chronic conditions with medical expenditures was assessed using multivariable regression with gamma distribution and log link. Analyses were adjusted for age, sex, race/ethnicity, education, and marital status. Expenses were adjusted for inflation to 2016 dollars. RESULTS Most AYA cancer survivors had ≥1 chronic condition (74%) and were diagnosed with cancer ≥10 years prior to the survey (76%). AYA cancer survivors with chronic conditions spent an additional $2777 (95% CI, $480 to $5958) annually compared to survivors with no chronic conditions. Additional annual expenses also were associated with physical inactivity ($3558; 95% CI, $2200 to $4606) and being unable to get care when needed ($1291; 95% CI, $198 to 3335). CONCLUSIONS Chronic conditions are associated with a substantial increase in medical expenses well after cancer diagnosis in AYA cancer survivors. IMPLICATION FOR CANCER SURVIVORS Getting care when needed and adopting healthy behaviors, particularly exercise, may reduce medical expenses associated with chronic conditions in AYAs.
Collapse
|
29
|
Folbrecht J, Mayorga L, Fulginiti K, Trujillo M, Joshi R, Namm J, Kelly N. Reduction of Distress and Attrition in a 6-Week Psychoeducational Group: A Pilot Study. J Adolesc Young Adult Oncol 2021; 11:56-60. [PMID: 33877913 DOI: 10.1089/jayao.2021.0030] [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: 11/12/2022] Open
Abstract
Purpose: The distress and unique needs of AYAs (adolescent/young adults) with an oncology diagnosis have been well explored and documented in the literature. However, effective means of reducing distress and meeting needs has been more elusive. This study explored the impact of a 6-week psychoeducational pilot group on AYA distress. Methods: Patient surveys and literature review were conducted to develop content for a 6-week psychoeducational group to reduce AYA distress through peer support and increased knowledge related to symptom management, physician communication, body image, family relationships, autonomy, sexuality, fertility, and coping skills. Distress was measured using the Hospital Anxiety and Depression Scale (HADS). Results: Twenty-one AYAs receiving oncology treatment enrolled in the group. Thirteen completed the program. Reasons for attrition included transportation, severity of symptoms, procedures, disinterest, and death. A correlated t-test demonstrated a significant decrease in HADS total score from pre- to post-test. Conclusion: This pilot study suggests that providing AYAs with information relative to their unique developmental needs and opportunities to process those needs in an environment of peers is challenging but can have benefit. nCT01817335.
Collapse
Affiliation(s)
- Jeanelle Folbrecht
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Lina Mayorga
- Department of Clinical Research, Methodist Hospital of Southern California
| | | | - Marisol Trujillo
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Renee Joshi
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - JoAnn Namm
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| | - Natalie Kelly
- Department of Supportive Care Medicine, City of Hope, Duarte, California, USA
| |
Collapse
|
30
|
McInally W, Gray-Brunton C, Chouliara Z, Kyle RG. Experiences of living with cancer of adolescents and young adults and their families: A narrative review and synthesis. ENFERMERIA CLINICA 2021; 31:S1130-8621(21)00034-6. [PMID: 33810981 DOI: 10.1016/j.enfcli.2020.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Adolescence is a critical life stage marked by significant physical, psychological, and social change. Cancer diagnosis during adolescence profoundly affects this experience for adolescents and young adults (AYA) and their families with an impact that continues throughout life. It is important to understand these experiences to ensure delivery of appropriate and high-quality supportive care. This narrative review critically appraised and synthesised qualitative literature that explored the experiences of AYAs and their families living with cancer. METHOD Narrative review and synthesis of qualitative research of AYAs' and their families' experiences of cancer. MEDLINE, CINAHL and PsycINFO were searched between February 2000 and September 2019 using search terms including "adolescent", "young people", "young adult", "cancer", "family", and "qualitative". Literature was appraised and synthesised using Popay et al.'s1 framework. RESULTS 3016 articles were retrieved (Medline n=1298, CINAHL n=1632, PsycINFO n=86). Of these, 151 duplicates were removed. 2865 papers were screened with 121 abstracts considered for eligibility for inclusion. Eighteen papers met the inclusion criteria. Three inter-related themes were identified: being diagnosed with cancer; uncertainty - holding on to life and gaps in care delivery. DISCUSSION AND RECOMMENDATIONS Few studies discuss the impact of cancer on the families of AYA living with cancer. Future research should explore this experience. By doing so the relational impact of cancer will be better understood as the basis of supportive family-centred care. PROSPERO Registration: CRD42017084148.
Collapse
Affiliation(s)
- Wendy McInally
- Faculty of Wellbeing, Education and Language Studies, Open University, Edinburgh, UK.
| | | | - Zoe Chouliara
- Faculty of Social & Health Sciences, Division of Mental Health & Counselling, Abertay University, Dundee, UK
| | - Richard G Kyle
- Research & Evaluation Division, Public Health Wales, Cardiff, UK
| |
Collapse
|
31
|
Lidington E, Darlington AS, Vlooswijk C, Beardsworth S, McCaffrey S, Tang S, Stallard K, Younger E, Edwards P, Ali AI, Nandhabalan M, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Gonzalez M, Sirohi B, Husson O, van der Graaf WTA. Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25-39 Years Old in the UK National Health Service. Clin Oncol (R Coll Radiol) 2021; 33:494-506. [PMID: 33722412 DOI: 10.1016/j.clon.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
AIMS Adolescents and young adults aged 15-39 years with cancer face unique medical, practical and psychosocial issues. In the UK, principal treatment centres and programmes have been designed to care for teenage and young adult patients aged 13-24 years in an age-appropriate manner. However, for young adults (YAs) aged 25-39 years with cancer, little access to age-specific support is available. The aim of this study was to examine this possible gap by qualitatively exploring YA care experiences, involving patients as research partners in the analysis to ensure robust results. MATERIALS AND METHODS We conducted a phenomenological qualitative study with YAs diagnosed with any cancer type between ages 25 and 39 years old in the last 5 years. Participants took part in interviews or focus groups and data were analysed using inductive thematic analysis. Results were shaped in an iterative process with the initial coders and four YA patients who did not participate in the study to improve the rigor of the results. RESULTS Sixty-five YAs with a range of tumour types participated. We identified seven themes and 13 subthemes. YAs found navigating the healthcare system difficult and commonly experienced prolonged diagnostic pathways. Participants felt under-informed about clinical details and the long-term implications of side-effects on daily life. YAs found online resources overwhelming but also a source of information and treatment support. Some patients regretted not discussing fertility before cancer treatment or felt uninformed or rushed when making fertility preservation decisions. A lack of age-tailored content or age-specific groups deterred YAs from accessing psychological support and rehabilitation services. CONCLUSIONS YAs with cancer may miss some benefits provided to teenagers and young adults in age-tailored cancer services. Improving services for YAs in adult settings should focus on provision of age-specific information and access to existing relevant support.
Collapse
Affiliation(s)
- E Lidington
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - C Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | | | | | - S Tang
- Imperial College Healthcare NHS Trust, London, UK; Public Health England, London, UK
| | | | - E Younger
- Royal Marsden NHS Foundation Trust, London, UK; Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Edwards
- Royal Marsden NHS Foundation Trust, London, UK
| | - A I Ali
- St George's University Hospital NHS Foundation Trust, London, UK
| | | | - A Din
- University of Southampton, Southampton, UK
| | - N Starling
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - S Stanway
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - S Banerjee
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - Z Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - M Gonzalez
- Imperial College Healthcare NHS Trust, London, UK
| | - B Sirohi
- Barts Health NHS Trust, London, UK; Apollo Proton Cancer Centre, Chennai, India
| | - O Husson
- Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| |
Collapse
|
32
|
Yélamos Agua C, Berzal Pérez E, de Haro Gázquez D, Fernández Sánchez B, Navarro Jiménez JM. Psychosocial impact of the COVID-19 outbreak and lockdown on Spanish oncological patients: a quantitative approach. J Psychosoc Oncol 2021; 39:385-398. [PMID: 33570014 DOI: 10.1080/07347332.2021.1880523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study analyses the levels of distress and related psychosocial factors among cancer patients during the Spanish lockdown due to COVID-19. METHODS A total of 2,779 cancer patients took part in an observational and lateral study carried out between April 16, 2020 and April 25, 2020. An online questionnaire was distributed including distress-related variables, demographic variables, clinical variables about their oncological condition, socioeconomic variables and variables related to information management and social communication. Distress was measured according to the Kessler (K-6) scale, and its relationship with the remaining variables was analyzed by logistic regression. RESULTS 33.5% of the patients yielded levels of clinical distress during lockdown. Younger patients and women yielded significantly higher levels of distress. High distress levels were generally associated with the following factors: trust in medical institutions; deterioration of the household's financial conditions; and media management of the information about the pandemic. CONCLUSIONS The lockdown triggered by COVID-19 increased distress among cancer patients, and this can be significantly related to a number of variables. Identifying distress, and said factors, at an early stage can help to develop mitigation strategies. Similarly, early detection can help to improve the way information is shared with patients, offer them support and resources and direct them to psychosocial services, increasing the patient's ability to return to normal after COVID-19.
Collapse
|
33
|
Self-efficacy in symptom management for adolescents and young adults with cancer: a systematic review. Support Care Cancer 2021; 29:2851-2862. [PMID: 33403400 DOI: 10.1007/s00520-020-05960-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) have more frequent and intense adverse effects from cancer therapy than other age groups. Self-efficacy, the ability for persons to maintain health-related behavior change, may assist with symptom management but the role it plays in AYAs with cancer has not been thoroughly investigated. This review explores the role that self-efficacy has in symptom management for AYAs with cancer and provides guidance for clinicians to utilize self-efficacy as a means to reduce side effects of therapy. METHODS A systematic review of peer-reviewed literature was conducted to identify works discussing self-efficacy and symptom management for AYAs with cancer. Five databases were searched with key terms and articles that discussed relationships between self-efficacy and cancer therapy symptoms were retained for analysis. FINDINGS Twelve manuscripts representing 1180 individuals age 12 to 43 years were identified. Self-efficacy was found to be related to (1) health management behaviors, (2) psychosocial health, (3) sexual and reproductive health, and (4) physical symptoms. Self-efficacy had direct correlations with physical activity, nutritional intake, symptom regulation, mental health, sexual health, and fertility preservation. The included studies did not find significant relationships with medication adherence or pain management. DISCUSSION Self-efficacy is an attribute that impacts behavior change, health maintenance, and overall wellness and can be changed over time and through interventions to improve symptoms of cancer therapy. Self-efficacy should be evaluated as a construct in relevant studies aimed at improving side effects of cancer therapy to better understand outcomes from interventions. Symptoms, toxicities, and adverse effects of cancer therapy may be improved by increasing self-efficacy of patients.
Collapse
|
34
|
Trivedi N, Moser RP, Breslau ES, Chou WYS. Predictors of Patient-Centered Communication among U.S. Adults: Analysis of the 2017-2018 Health Information National Trends Survey (HINTS). JOURNAL OF HEALTH COMMUNICATION 2021; 26:57-64. [PMID: 33648425 DOI: 10.1080/10810730.2021.1878400] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An essential component of patient-centered care is the communication between patients and their providers, which can affect patients' health outcomes A cancer care model, developed by Epstein and Street, includes a multi-dimensional patient-centered communication (PCC) framework with six functions: foster healing relationships, exchange information, respond to emotions, manage uncertainty, make decisions, and enable patient self-management. Seven domains that describe the functions were included on the Health Information National Trends Survey (HINTS) to assess PCC. We examined the association between sociodemographic and health-related factors and PCC as well as how U.S. adults, by different age groups, ranked different domains of PCC.Nationally representative data (n = 5,738) from 2017 to 2018 HINTS were merged to examine predictors of PCC among U.S. adults. Weighted statistics describe the study sample and prevalence for ratings of PCC domains. A multivariate linear regression model was computed to assess associations among predictors and PCC.Participants rated their communication with doctors in the last year with an overall mean of 80 out of 100. Older age, those reporting excellent health, and those with higher confidence in taking care of one's health predicted better PCC. Individuals who reported being non-Hispanic Asian and having lower household income were associated with poorer communication. Participants' lowest rating of PCC concentrated on providers dealing with their emotional needs.Findings suggest that many patients do not feel that their providers adequately manage, communicate, nor respond to their emotional needs. Future efforts should enhance interpersonal exchanges among sub-populations who report poorer communication with providers during clinical visits.
Collapse
Affiliation(s)
- Neha Trivedi
- Behavioral Research Program, Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, MD USA
| | - Richard P Moser
- Behavioral Research Program, Office of the Associate Director, National Cancer Institute, Rockville, MD USA
| | - Erica S Breslau
- Healthcare Delivery Research Program, Health Systems and Interventions Research Branch, National Cancer Institute, Rockville, MD USA
| | - Wen-Ying Sylvia Chou
- Behavioral Research Program, Health Communication and Informatics Research Branch, National Cancer Institute, Rockville, MD USA
| |
Collapse
|
35
|
Salsman JM, Danhauer SC, Moore JB, Canzona MR, Victorson DE, Zebrack BJ, Reeve BB. Optimizing the measurement of health-related quality of life in adolescents and young adults with cancer. Cancer 2020; 126:4818-4824. [PMID: 32910454 PMCID: PMC8005324 DOI: 10.1002/cncr.33155] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/07/2022]
Abstract
To date, the health‐related quality of life experiences of adolescents and young adults (AYA) with cancer have been inconsistently and incompletely captured by existing patient‐reported outcome (PRO) measures. The National Institutes of Health Patient‐Reported Outcomes Measurement Information System (PROMIS) represents the state of the art for measurement science of PROs and provides an optimal approach for addressing these measurement challenges and catalyzing future patient‐centered research in AYA oncology.
Collapse
Affiliation(s)
- John M. Salsman
- Department of Social Sciences and Health Policy, Wake
Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center,
Winston-Salem, North Carolina
| | - Suzanne C. Danhauer
- Department of Social Sciences and Health Policy, Wake
Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center,
Winston-Salem, North Carolina
| | - Justin B. Moore
- Department of Implementation Science, Wake Forest School of
Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North
Carolina
| | - Mollie R. Canzona
- Department of Social Sciences and Health Policy, Wake
Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center,
Winston-Salem, North Carolina
- Department of Communication, Wake Forest University,
Winston-Salem, North Carolina
| | - David E. Victorson
- Department of Medical Social Sciences, Northwestern
University Feinberg School of Medicine , Robert H. Lurie Comprehensive Cancer
Center, Chicago, Illinois
| | | | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University
School of Medicine, Duke Cancer Institute, Durham, North Carolina
| |
Collapse
|
36
|
Gupta S, Mazza MC, Hoyt MA, Revenson TA. The experience of financial stress among emerging adult cancer survivors. J Psychosoc Oncol 2020; 38:435-448. [PMID: 31983313 PMCID: PMC7316584 DOI: 10.1080/07347332.2019.1707928] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: The experience of cancer-related financial stress was examined within the developmental context of emerging adulthood.Methodological approach: This study is a secondary analysis of data drawn from two samples of testicular or hematologic cancer survivors. In-depth interviews from 52 emerging adult (EA) cancer survivors, ages 18-29, were coded by combining thematic analysis with an abductive approach.Findings: Emergent themes included some common to most age groups, including worries about medical costs and availability of health insurance, as well as specific age-related concerns, such as fertility preservation. Financial stress appeared to interrupt developmental tasks of emerging adulthood, including completing an education, establishing independence, and managing relationships. Surprisingly, financial stress was experienced as a benefit for some participants.Conclusion: Financial stress affects EA cancer survivors in unique ways. To provide support, health professionals should consider survivors' developmental life stage to understand their financial stress, and ultimately, to improve quality of life.
Collapse
Affiliation(s)
| | | | | | - Tracey A. Revenson
- The Graduate Center, City University of New York
- Hunter College, City University of New York
| |
Collapse
|
37
|
Greenzang KA, Fasciano KM, Block SD, Mack JW. Early information needs of adolescents and young adults about late effects of cancer treatment. Cancer 2020; 126:3281-3288. [PMID: 32365227 DOI: 10.1002/cncr.32932] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer survivors have high risks of late effects. Little is known about the late-effect information needs of AYAs early in treatment or their role in treatment decision making. This study evaluated the importance, quality, and implications of information about late effects in AYAs recently diagnosed with cancer. METHODS This study surveyed 201 AYAs with cancer who were 15 to 29 years old and were treated at the Dana-Farber Cancer Institute (Boston, Massachusetts). Patients were approached within 6 weeks of their diagnosis and were asked about their late-effect and infertility information needs, treatment decision making, and communication outcomes. RESULTS Forty-five percent of the participants were female; 88% were white. Most AYAs (87% [173 of 200]) considered information about the risks of late effects to be extremely or very important; 80% (159 of 200) valued information about infertility. Many were distressed by information about late effects (53% [105 of 200]) and infertility (45% [89 of 200]); those who considered late-effect information distressing were more likely to value this information (P < .0001). Consideration of late effects (41% [82 of 201]) and infertility (36% [72 of 201]) greatly influenced many patients' treatment decision making. Although 92% of the patients (184 of 199) reported receiving high-quality information about the diagnosis, 57% (113 of 199; P < .0001) and 65% (130 of 199; P < .0001) felt that they had received high-quality information about late effects and infertility, respectively. CONCLUSIONS Most AYAs with cancer value early information about the risks of late effects and infertility, yet many patients felt that they had not received high-quality information about these topics. The development of age-appropriate late-effect communication strategies that recognize high AYA distress may help to address the gap between desired information and perceived information quality.
Collapse
Affiliation(s)
- Katie A Greenzang
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Karen M Fasciano
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan D Block
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
38
|
Work- and insurance-related issues among Asian adolescent and young-adult cancer survivors: a qualitative study. Support Care Cancer 2020; 28:5901-5909. [PMID: 32270310 DOI: 10.1007/s00520-020-05430-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Work-related issues among Asian adolescent and young-adult (AYA) cancer survivors are poorly described in the literature. There has also been a paucity of reports regarding insurance-related concerns in this patient population. Focus groups were therefore carried out in Singapore to understand survivorship issues related to work and insurance coverage among Asian AYA cancer survivors. METHODS Twenty-three AYA survivors and 18 healthcare professionals (HCPs) who care for AYA cancer patients were recruited for 11 focus group sessions. Thematic content analysis was carried out to identify major themes that emerged. RESULTS Similar themes emerged from AYA and HCP focus groups. The majority of AYA survivors were eager to return to work post-treatment. However, some survivors were worried about not keeping up with expectations and struggled with disclosure of their medical history. In contrast, several survivors leveraged on their experience with cancer to bolster job opportunities. Despite facing challenges due to complications from cancer and restrictions at work, AYA survivors preferred to be treated normally. AYA survivors also expressed concerns about inadequate insurance coverage and a lack of information on this topic. CONCLUSION Contrary to expectations, Asian AYA survivors are motivated to return to work and address work-related challenges. Inadequate insurance coverage remains a pressing concern despite the availability of public health insurance and subsidies. Career coaches and financial counselors should be incorporated into survivorship care to aid AYA survivors.
Collapse
|
39
|
Ke Y, Tan CJ, Ng T, Tan IMJ, Goh WL, Poon E, Farid M, Neo PSH, Srilatha B, Chan A. Optimizing Survivorship Care Services for Asian Adolescent and Young Adult Cancer Survivors: A Qualitative Study. J Adolesc Young Adult Oncol 2020; 9:384-393. [PMID: 31934810 DOI: 10.1089/jayao.2019.0145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: With an increasing focus on developing survivorship services tailored for adolescent and young adult (AYA) cancer survivors, incorporation of viewpoints from both survivors and health care professionals (HCPs) is important. This study aims to explore the perceptions of current and prospective survivorship services from both groups in Singapore to propose service design and delivery strategies. Methods: Focus group discussions with 23 AYA cancer survivors between the ages of 16 and 39 years at diagnosis and 18 HCPs were conducted in National Cancer Centre Singapore (NCCS) and Singapore Cancer Society (SCS). All focus group discussions were transcribed verbatim. Deductive thematic analysis was performed according to the components of a design thinking model: empathizing with AYA survivors, defining care gaps, proposing services, and implementation strategies. Results: AYA survivors preferred age-specific services that are aligned with their personal goals. Current survivorship care failed to address the needs of survivors' dependents (caregivers and children) and to consider the utility of each service temporally. Prospective services should clarify disease disclosure obligation in job search and introduce a care navigator. Key implementation strategies included (1) training HCPs on communication techniques with AYA, (2) selecting engagement platforms that complement survivors' information-seeking behavior, (3) improving outreach to survivors through appropriate branding and publicity, and (4) consolidating services from multiple providers. Conclusions: The design of survivorship care services for AYA survivors should be systematic in its conceptualization process and employ implementation strategies. The coordination of the wide spectrum of services warrants a concerted effort by cancer centers, community partners, and the government.
Collapse
Affiliation(s)
- Yu Ke
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Chia Jie Tan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Tabitha Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Isabel Mei Jun Tan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Wei Lin Goh
- Divisions of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Poon
- Divisions of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Divisions of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Patricia Soek Hui Neo
- Divisions of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Alexandre Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School Singapore, Singapore, Singapore
| |
Collapse
|
40
|
Lin B, Gutman T, Hanson CS, Ju A, Manera K, Butow P, Cohn RJ, Dalla‐Pozza L, Greenzang KA, Mack J, Wakefield CE, Craig JC, Tong A. Communication during childhood cancer: Systematic review of patient perspectives. Cancer 2019; 126:701-716. [DOI: 10.1002/cncr.32637] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Beryl Lin
- School of Public Health University of Sydney Sydney New South Wales Australia
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
| | - Talia Gutman
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Camilla S. Hanson
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Angela Ju
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Karine Manera
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Phyllis Butow
- Psycho‐oncology Co‐operative Research Group School of Psychology University of Sydney Sydney New South Wales Australia
| | - Richard J. Cohn
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Luciano Dalla‐Pozza
- Cancer Centre for Children The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Katie A. Greenzang
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Dana‐Farber Cancer Institute Boston Massachusetts
| | - Jennifer Mack
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Dana‐Farber Cancer Institute Boston Massachusetts
| | - Claire E. Wakefield
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
- Kids Cancer Centre Sydney Children's Hospital Randwick New South Wales Australia
| | - Jonathan C. Craig
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Allison Tong
- School of Public Health University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research The Children's Hospital at Westmead Westmead New South Wales Australia
| |
Collapse
|
41
|
Pflugeisen BM, Patterson P, Macpherson CF, Ray BC, Jacobsen RL, Hornyak N, Johnson RH. Putting Adolescents and Young Adults in a Room Together: Launching an Adolescent and Young Adult Oncology Council. J Adolesc Young Adult Oncol 2019; 8:540-546. [DOI: 10.1089/jayao.2018.0139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Pandora Patterson
- CanTeen Australia, Sydney, Australia
- Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
| | | | - Bernadette C. Ray
- MultiCare Health System, Institute for Research & Innovation, Tacoma, Washington
| | - Rebecca L. Jacobsen
- MultiCare Health System, Institute for Research & Innovation, Tacoma, Washington
| | | | - Rebecca H. Johnson
- Division of Pediatric Hematology/Oncology, MultiCare Health System, Mary Bridge Children's Hospital, Tacoma, Washington
| |
Collapse
|
42
|
Abstract
Adolescents and young adults (AYAs) with cancer constitute a particular group of patients with unique features, whose needs during and after treatment are poorly met. A standardized model of care for them has yet to be established, as neither the pediatric nor the adult oncology systems seamlessly fit their needs. Regardless of the setting in which they are treated, their health care providers should be aware of the impact that the disease and its treatments have on these especially vulnerable patients. Simple ways of improving the AYA experience should be considered: reducing isolation through connections with peers, adapting the staff's approach to the emotional and developmental needs of this age group, and modifying the hospital environment making it more age appropriate. Commitment of national governments is valuable; building and sharing international experience will accelerate advances in clinical care, education, and research. Further progress in the care of AYA cancer patients is still needed to improve their outcomes.
Collapse
|
43
|
Drew D, Kable A, van der Riet P. The adolescent’s experience of cancer: An integrative literature review. Collegian 2019. [DOI: 10.1016/j.colegn.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
44
|
Fidler MM, Frobisher C, Hawkins MM, Nathan PC. Challenges and opportunities in the care of survivors of adolescent and young adult cancers. Pediatr Blood Cancer 2019; 66:e27668. [PMID: 30815985 DOI: 10.1002/pbc.27668] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 02/06/2023]
Abstract
Adolescents and young adults (AYA) with cancer are an understudied group. Much of what is known about long-term outcomes after AYA cancer has been derived from cohorts of childhood cancer survivors, which seldom include patients at the older end of the AYA age spectrum. In general, AYA cancer survivors have a lower risk for premature mortality, subsequent primary neoplasms and chronic health conditions than childhood cancer survivors. However, AYA cancer survivors are vulnerable to psychosocial challenges, concerns about fertility and relationships and financial toxicity. No single model is optimal for the care of these survivors, but it is generally agreed that all survivors require a survivor care plan that promotes their adherence to evidence-based surveillance guidelines. There is a need to create survivor cohorts that include the full range of AYA ages and diagnoses to be able to address the many pressing questions that remain unanswered in this vulnerable population.
Collapse
Affiliation(s)
- Miranda M Fidler
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
45
|
Murphy-Banks R, Blanch-Hartigan D, Boehm L, Hamel PC, Parsons SK. Personal Narrative: Raising Awareness of Adolescent and Young Adult Cancer Survivors in Similarly Aged University Students. J Adolesc Young Adult Oncol 2019; 8:434-441. [PMID: 31038376 DOI: 10.1089/jayao.2018.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: As part of a programmatic educational initiative, we developed a personal narrative presentation, embedded with evidence-based data, to raise awareness of adolescents and young adults (AYAs) who have been diagnosed with cancer between the ages of 15 and 39 years among similarly aged university students. The narrative encompassed the cancer care continuum from signs of the disease through survivorship and incorporated psychosocial aspects of the experience. Methods: The presenter, diagnosed with lymphoma at the age of 25 years in 2007, interwove AYA data with her narrative in a series of 26 invited lectures given over 2 academic years, 2016-2017 and 2017-2018. Students were asked to provide anonymous open-ended feedback. Six hundred thirteen forms were collected and retrospectively dually coded and analyzed. Results: The majority of students (97%) referenced at least one of the presentation's three objectives: (1) build awareness of the AYA demographic; (2) encourage a personal health care focus; and (3) expand awareness of the far-reaching impact of cancer (i.e., psychological, social, and medical) both during and beyond the treatment phase. Format- and/or content-related suggestions and potential benefits of hearing the narrative also were reported. Conclusion: The use of personal narrative to raise awareness of the AYA cancer experience in an academic setting is both feasible and effective. Students demonstrated a new or enhanced understanding of AYA cancer and its biopsychosocial implications. We provide evidence to inform the design of awareness interventions directed at similarly aged university students.
Collapse
Affiliation(s)
- Rachel Murphy-Banks
- 1Reid R. Sacco Adolescent and Young Adult Cancer Program at Tufts Medical Center, Boston, Massachusetts
| | | | - Lauren Boehm
- 1Reid R. Sacco Adolescent and Young Adult Cancer Program at Tufts Medical Center, Boston, Massachusetts
| | - Pauline C Hamel
- 3Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Susan K Parsons
- 1Reid R. Sacco Adolescent and Young Adult Cancer Program at Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
46
|
Taylor RM, Fern LA, Barber J, Alvarez-Galvez J, Feltbower R, Morris S, Hooker L, McCabe MG, Gibson F, Raine R, Stark DP, Whelan JS. Description of the BRIGHTLIGHT cohort: the evaluation of teenage and young adult cancer services in England. BMJ Open 2019; 9:e027797. [PMID: 31005941 PMCID: PMC6500338 DOI: 10.1136/bmjopen-2018-027797] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE International recognition of the unique needs of young people with cancer is growing. Many countries have developed specialist age-appropriate cancer services believing them to be of value. In England, 13 specialist principal treatment centres (PTCs) deliver cancer care to young people. Despite this expansion of specialist care, systematic investigation of associated outcomes and costs has, to date, been lacking. The aim of this paper is to describe recruitment and baseline characteristics of the BRIGHTLIGHT cohort and the development of the bespoke measures of levels of care and disease severity, which will inform the evaluation of cancer services in England. DESIGN Prospective, longitudinal, observational study. SETTING Ninety-seven National Health Service hospitals in England. PARTICIPANTS A total of 1114 participants were recruited and diagnosed between July 2012 and December 2014: 55% (n=618) were men, mean age was 20.1 years (SD=3.3), most (86%) were white and most common diagnoses were lymphoma (31%), germ cell tumour (19%) and leukaemia (13%). RESULTS At diagnosis, median quality of life score was significantly lower than a published control threshold (69.7 points); 40% had borderline to severe anxiety, and 21% had borderline to severe depression. There was minimal variation in other patient-reported outcomes according to age, diagnosis or severity of illness. Survival was lower in the cohort than for young people diagnosed during the same period who were not recruited (cumulative survival probability 4 years after diagnosis: 88% vs 92%). CONCLUSIONS Data collection was completed in March 2018. Longitudinal comparisons will determine outcomes and costs associated with access/exposure to PTCs. Findings will inform international intervention and policy initiatives to improve outcomes for young people with cancer.
Collapse
Affiliation(s)
- Rachel M Taylor
- Cancer Clinical Trials, University College Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southhamptom, Southampton, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Faith Gibson
- ORCHID, Great Ormond Street Hospital For Children NHS Trust, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Rosalind Raine
- Institute of Epidemiology & Health, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy S Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
47
|
Reblin M, Stanley NB, Galligan A, Reed D, Quinn GP. Family dynamics in young adult cancer caregiving: “It should be teamwork”. J Psychosoc Oncol 2019; 37:526-540. [DOI: 10.1080/07347332.2018.1563582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Nathanael B. Stanley
- Moffitt Cancer Center, Tampa, Florida, USA
- University of South Florida, Tampa, Florida, USA
| | | | - Damon Reed
- Moffitt Cancer Center, Tampa, Florida, USA
| | | |
Collapse
|
48
|
Miscorrelation of Functional Outcome and Sociooccupational Status of Childhood, Adolescent, and Young Adult Generation With Bone and Soft Tissue Sarcoma Patients. J Pediatr Hematol Oncol 2019; 41:112-117. [PMID: 30688829 DOI: 10.1097/mph.0000000000001410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Few studies have examined the relationship between functional outcome and sociooccupational or psychological status in adolescent and young adults (AYA) generation and childhood sarcoma patients. We retrospectively analyzed clinical (prognostic and functional) and sociooccupational outcomes in 50 patients; 22 children aged under 14 years and 28 AYAs generation (15 to 29 y). There were 35 cases of bone sarcomas and 15 of soft tissue sarcomas. Limb-sparing surgery was performed in 30 of 37 extremity cases. The most prevalent problems among patients were as follows: limited activities; drop-out or delayed studies among high school and college students; limitation in job searching; and changes in social relationships. These problems were unaffected by limb-sparing. Regression analysis between functional and sociooccupational disability showed that the correlation coefficient was significant (P=0.005) in all limb-salvaged patients, but there was no significant correlation among osteosarcoma patients (P=0.07). These findings suggest that quality of life is a multidimensional measure: it depends on physical status, spiritual health, and social well-being of both patients and family members. To overcome the disadvantages of this type of disease, it is essential to provide comprehensive care at the earliest convenience using multidimensional approaches.
Collapse
|
49
|
Parsons HM, Muffly L, Alvarez EM, Keegan THM. Does Treatment Setting Matter? Evaluating Resource Utilization for Adolescents Treated in Pediatric vs Adult Cancer Institutions. J Natl Cancer Inst 2019; 111:224-225. [PMID: 30053066 DOI: 10.1093/jnci/djy123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Helen M Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA
| | - Elysia M Alvarez
- Division of Hematology Oncology, Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | - Theresa H M Keegan
- Division of Hematology and Oncology, Center for Oncology Hematology Outcomes Research and Training , University of California Davis School of Medicine, Sacramento, CA
| |
Collapse
|
50
|
Marshall S, Grinyer A, Limmer M. Dual Liminality: A Framework for Conceptualizing the Experience of Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:26-31. [DOI: 10.1089/jayao.2018.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steve Marshall
- Department of Palliative Care, Policy and Rehabilitation, King's College Hospital NHS Foundation Trust, Cicely Saunders Institute, London, United Kingdom
| | - Anne Grinyer
- Department of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, United Kingdom
| | - Mark Limmer
- Department of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, United Kingdom
| |
Collapse
|