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Fernando RA. Improving Supportive and Palliative Care Integration in Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2024; 13:271-280. [PMID: 37878271 DOI: 10.1089/jayao.2023.0096] [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: 10/26/2023] Open
Abstract
Purpose: Timely supportive and palliative care (SPC) integration in adolescent and young adult (AYA) cancer management is recommended in curative and palliative settings. However, multiple barriers exist to implementing this goal. Liverpool Cancer Therapy Center (LCTC) serviced a growing AYA (15-39 years) population without AYA-dedicated services and the vast majority receiving no SPC engagement. Concerned this was placing AYA patients' wellbeing at risk, we determined a cultural change was required and that the newly established AYA Supportive and Palliative Care (AYASPC) Service could facilitate this. Methods: The AYASPC Service conducted a 6-month quality improvement project aiming to increase its referrals from a baseline average of one per month to four per month, to increase confidence in making SPC referrals and to enhance appreciation for specialized AYA care. Interventions included formalizing an AYASPC referral pathway with broad indications, and educating clinicians on holistic AYA care, the AYASPC Service's model of care (MoC) and AYASPC referral benefits. Results: During the project, 27 AYASPC referrals were made. Referrals consistently exceeded the Service's baseline, and from 3 months onward exceeded the project target. Additionally, referrals were made earlier (29.6% at diagnosis), for a variety of cancer diagnoses with varied prognoses, and for indications beyond traditional issues of complex symptoms and end-of-life care. Clinicians also expressed greater confidence in supporting AYAs and making SPC referrals. Conclusion: In a brief timeframe, the AYASPC Service's innovative and adaptable MoC and project interventions sustainably improved AYASPC access and affected a positive cultural shift around AYA care and advocacy.
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Patterson P, Jacobsen RL, McDonald FE, Pflugeisen CM, Bibby K, Macpherson CF, Thompson K, Murnane A, Anazodo A, Sansom-Daly UM, Osborn MP, Hayward A, Kok C, Johnson RH. Beyond Medical Care: How Different National Models of Care Impact the Experience of Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2023; 12:859-867. [PMID: 37219896 PMCID: PMC10739785 DOI: 10.1089/jayao.2022.0182] [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: 05/24/2023] Open
Abstract
Patient experience is positively associated with clinical effectiveness, quality care, and patient safety. This study examines the experience of care of adolescents and young adult (AYA) cancer patients from Australia and the United States, allowing a comparison of patient experiences in the context of different national models of cancer care delivery. Participants (n = 190) were aged 15-29 years and received cancer treatment from 2014 to 2019. Australians (n = 118) were recruited nationally by health care professionals. U.S. participants (n = 72) were recruited nationally via social media. The survey included demographic and disease variables, and questions regarding medical treatment, information and support provision, care coordination, and satisfaction across the treatment pathway. Sensitivity analyses examined the possible contribution of age and gender. Most patients from both countries were satisfied or very satisfied with their medical treatment (chemotherapy, radiotherapy, and surgery). There were significant differences between countries in the provision of fertility preservation services, age-appropriate communication, and psychosocial support. Our findings suggest when a national system of oversight with both state and federal funding is implemented, as is the case in Australia but not in the United States, significantly more AYAs with cancer receive age-appropriate information and support services, and improved access to specialist services such as fertility care. A national approach with government funding and centralized accountability appears to be associated with substantial benefits for the well-being of AYAs undergoing cancer treatment.
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Affiliation(s)
- Pandora Patterson
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca L. Jacobsen
- Mary Bridge Children's Hospital, MultiCare Health System, Tacoma, Washington, USA
| | - Fiona E.J. McDonald
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Chaya M. Pflugeisen
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, USA
| | - Kit Bibby
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
| | | | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Australia
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Melbourne, Australia
| | | | - Ursula M. Sansom-Daly
- NSW/ACT Youth Cancer Service, Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, University of New South Wales Sydney, Sydney, Australia
| | - Michael P. Osborn
- SA/NT Youth Cancer Service, Adelaide, Australia
- Haematology/Oncology, Women's and Children's Hospital, North Adelaide, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Cindy Kok
- Impact and Patient Programs, Canteen Australia, Sydney, Australia
| | - Rebecca H. Johnson
- Mary Bridge Children's Hospital, MultiCare Health System, Tacoma, Washington, USA
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Hughes L, Fern LA, Whelan JS, Taylor RM, Study Group B. Young people's opinions of cancer care in England: the BRIGHTLIGHT cohort. BMJ Open 2023; 13:e069910. [PMID: 37730384 PMCID: PMC10514633 DOI: 10.1136/bmjopen-2022-069910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 07/31/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVES The BRIGHTLIGHT cohort study was the national evaluation of cancer services for teenager and young adults (TYA). This was analysis of free-text survey data to better understand their experiences of cancer care. DESIGN Cohort study SETTING: National Health Service hospitals delivering cancer care in England PARTICIPANTS: 830 young people newly diagnosed with cancer. INTERVENTIONS Exposure to specialist care in the first 6 months after diagnosis defined as care in a TYA Principal Treatment Centre (PTC). This was categorised as follows: all care in a TYA-PTC (ALL-TYA-PTC), no care in a TYA-PTC (NO-TYA-PTC) so care delivered in a children/adult unit only and some care in a TYA-PTC with additional care in a children's/adult unit (SOME-TYA-PTC). PRIMARY OUTCOME Data were collected through the BRIGHTLIGHT survey included free-text questions which asked patients 'what was the best aspects of their experiences of care' and 'what aspects could be improved'. These comments were analysed using content analysis. Themes were compared between categories of care, then ranked in order of frequency, ranging from the most endorsed to the least. RESULTS Overall, young people were most positive about their healthcare team, while the area highlighted for improvement was diagnostic experience. Differences between the three groups suggested those who had some or all treatment in a TYA-PTC valued the place of care. Regardless of where TYA were treated their healthcare teams were favourably viewed. Age appropriate place of care was highlighted to be of value for those in PTCs. CONCLUSIONS These data show the value young people placed on the care they received in TYA specific wards. Young people who accessed some or all of their care in a TYA-PTC highly endorsed their place of care as one of the best elements of their care, and it is further emphasised by those who had shared care who experienced difficulty with lack of age-appropriate care when treated outside the TYA-PTC.
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Affiliation(s)
- Luke Hughes
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Brightlight Study Group
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, London, UK
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Choi E, Becker H, Jung H. Health-related quality of life in adolescents and young adults with and without cancer, using propensity score matching. J Cancer Surviv 2023; 17:279-289. [PMID: 34850323 DOI: 10.1007/s11764-021-01150-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess health-related quality of life (HRQOL) among adolescents and young adults (AYAs) with and without cancer, using Andersen's behavioral model of health services use. METHODS We used a cross-sectional, matched case-control design; data were from the Texas Behavioral Risk Factor Surveillance System for 2015-2019. AYAs aged between 18 and 39 years and with cancer were matched to controls using propensity score matching to control for predisposing and enabling factors. Chi-square tests were used to compare differences in need for care, health practices, and health services utilization between AYAs with cancer and controls without cancer. Multiple logistic regression models were used to compare HRQOL outcomes. RESULTS The final study sample consisted of 276 AYAs diagnosed with cancer and 828 controls after propensity score matching. The AYAs with cancer were more likely to have chronic comorbidities, smoke, and avoid health services utilization because of cost in comparison with the matched controls. Multiple logistic regressions showed significant differences in HRQOL between AYAs with cancer and controls: AYAs with cancer were more likely to have worse general health (OR = 2.488; 95% CI, 1.305-4.741) and worse perceived cognitive function (OR = 2.070; 95% CI, 1.076-3.919). CONCLUSION AYAs with cancer experience more chronic comorbidities, smoking, financial barriers to health service, and worse HRQOL than do AYAs without cancer. IMPLICATIONS FOR CANCER SURVIVORS Age-appropriate tailored surveillance and survivorship supports/resources are needed for AYAs with cancer.
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Affiliation(s)
- Eunju Choi
- Department of Nursing, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Heather Becker
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA
| | - Hyekyung Jung
- Department of Human Resource and Development, Korea University of Technology and Education, 1600 Chungjeol-ro, Byengcheon-myeon, Dongnam-gu, Cheonan-si, 31253, South Korea
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Patterson P, McDonald FEJ, Allison KR, Bibby H, Osborn M, Matthews K, Sansom-Daly UM, Thompson K, Plaster M, Anazodo A. The Clinical Utility of the Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST): Perspectives of AYA Cancer Patients and Healthcare Professionals. Front Psychol 2022; 13:872830. [PMID: 35602702 PMCID: PMC9120841 DOI: 10.3389/fpsyg.2022.872830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Routine psychosocial screening and assessment of people diagnosed with cancer are crucial to the timely detection of distress and provision of tailored supportive care; however, appropriate screening tools have been lacking for adolescents and young adults (AYAs), who have unique needs and experiences. One exception is the recently validated AYA Psycho-Oncology Screening Tool (AYA-POST) for use with young people aged 15–29 years, which comprises a distress thermometer and age-specific needs assessment. This study investigates the clinical utility of this measure, as well as the subsequent service responsiveness within the Australian Youth Cancer Services. Method In total, 118 AYAs and 29 healthcare professionals: (HCPs) completed surveys about the clinical utility of the AYA-POST; a subset of 30 AYAs completed a 3-month follow-up survey assessing service responsiveness. Descriptive statistics (frequencies/means) were computed for all items, with chi-square analyses used to explore whether perceived clinical utility varied with AYA age, AYA sex, HCP discipline or HCP length of time using the AYA-POST. Results Participants’ responses demonstrate high levels of satisfaction with the tool, evidencing its appropriateness, practicability and acceptability. Moreover, the AYA-POST was reported to facilitate communication about psychosocial needs and prompt referrals, indicating good service responsiveness. Ratings of clinical utility did not differ significantly between AYA and HCP groups. Conclusion This study demonstrates that the AYA-POST is an appropriate tool in the psychosocial screening of AYAs with cancer, facilitating the identification of distress and unique concerns in this population and valuable in triaging and tailoring care for young cancer patients.
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Affiliation(s)
- Pandora Patterson
- Canteen Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Pandora Patterson,
| | - Fiona E. J. McDonald
- Canteen Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Michael Osborn
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Matthews
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
| | - Ursula M. Sansom-Daly
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
- Behavioural Sciences Unit, School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Kate Thompson
- Victoria/Tasmania Youth Cancer Service, Melbourne, VIC, Australia
| | - Meg Plaster
- Western Australia Youth Cancer Service, Perth, WA, Australia
| | - Antoinette Anazodo
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Lea S, Taylor R, Gibson F. Developing, Nurturing, and Sustaining an Adolescent and Young Adult-Centered Culture of Care. QUALITATIVE HEALTH RESEARCH 2022; 32:956-969. [PMID: 35356832 DOI: 10.1177/10497323221084910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Adolescents and young adults have unique needs which differ from those of children or adults. In the United Kingdom, we have dedicated services, which are diverse in how they are managed and delivered. A multiple-case study was conducted in young people's cancer services in four geographical regions of England. Data collection included: semi-structured interviews with healthcare professionals (n = 41) and young people (n = 29); and observation (total = 120 hours). Thematic analysis was used to synthesize and interpret five emerging themes describing the way a culture of adolescent and young adult-specific care developed. To develop a cultural attitude which embraced and promoted core values, leadership was needed, as well as high patient volume accessing a service. Time was essential, an adolescent and young adult-centered culture of care does not happen overnight, it needs time and dedicated staff to evolve, but once in place, services have a significant impact on the experience of care.
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Affiliation(s)
- Sarah Lea
- 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel Taylor
- 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey
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Taylor RM, Fern LA, Barber J, Gibson F, Lea S, Patel N, Morris S, Alvarez-Galvez J, Feltbower R, Hooker L, Martins A, Stark D, Raine R, Whelan JS. Specialist cancer services for teenagers and young adults in England: BRIGHTLIGHT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
When cancer occurs in teenagers and young adults, the impact is far beyond the physical disease and treatment burden. The effect on psychological, social, educational and other normal development can be profound. In addition, outcomes including improvements in survival and participation in clinical trials are poorer than in younger children and older adults with similar cancers. These unique circumstances have driven the development of care models specifically for teenagers and young adults with cancer, often focused on a dedicated purpose-designed patient environments supported by a multidisciplinary team with expertise in the needs of teenagers and young adults. In England, this is commissioned by NHS England and delivered through 13 principal treatment centres. There is a lack of evaluation that identifies the key components of specialist care for teenagers and young adults, and any improvement in outcomes and costs associated with it.
Objective
To determine whether or not specialist services for teenagers and young adults with cancer add value.
Design
A series of multiple-methods studies centred on a prospective longitudinal cohort of teenagers and young adults who were newly diagnosed with cancer.
Settings
Multiple settings, including an international Delphi study of health-care professionals, qualitative observation in specialist services for teenagers and young adults, and NHS trusts.
Participants
A total of 158 international teenage and young adult experts, 42 health-care professionals from across England, 1143 teenagers and young adults, and 518 caregivers.
Main outcome measures
The main outcomes were specific to each project: key areas of competence for the Delphi survey; culture of teenagers and young adults care in the case study; and unmet needs from the caregiver survey. The primary outcome for the cohort participants was quality of life and the cost to the NHS and patients in the health economic evaluation.
Data sources
Multiple sources were used, including responses from health-care professionals through a Delphi survey and face-to-face interviews, interview data from teenagers and young adults, the BRIGHTLIGHT survey to collect patient-reported data, patient-completed cost records, hospital clinical records, routinely collected NHS data and responses from primary caregivers.
Results
Competencies associated with specialist care for teenagers and young adults were identified from a Delphi study. The key to developing a culture of teenage and young adult care was time and commitment. An exposure variable, the teenagers and young adults Cancer Specialism Scale, was derived, allowing categorisation of patients to three groups, which were defined by the time spent in a principal treatment centre: SOME (some care in a principal treatment centre for teenagers and young adults, and the rest of their care in either a children’s or an adult cancer unit), ALL (all care in a principal treatment centre for teenagers and young adults) or NONE (no care in a principal treatment centre for teenagers and young adults). The cohort study showed that the NONE group was associated with superior quality of life, survival and health status from 6 months to 3 years after diagnosis. The ALL group was associated with faster rates of quality-of-life improvement from 6 months to 3 years after diagnosis. The SOME group was associated with poorer quality of life and slower improvement in quality of life over time. Economic analysis revealed that NHS costs and travel costs were similar between the NONE and ALL groups. The ALL group had greater out-of-pocket expenses, and the SOME group was associated with greater NHS costs and greater expense for patients. However, if caregivers had access to a principal treatment centre for teenagers and young adults (i.e. in the ALL or SOME groups), then they had fewer unmet support and information needs.
Limitations
Our definition of exposure to specialist care using Hospital Episode Statistics-determined time spent in hospital was insufficient to capture the detail of episodes or account for the variation in specialist services. Quality of life was measured first at 6 months, but an earlier measure may have shown different baselines.
Conclusions
We could not determine the added value of specialist cancer care for teenagers and young adults as defined using the teenage and young adult Cancer Specialism Scale and using quality of life as a primary end point. A group of patients (i.e. those defined as the SOME group) appeared to be less advantaged across a range of outcomes. There was variation in the extent to which principal treatment centres for teenagers and young adults were established, and the case study indicated that the culture of teenagers and young adults care required time to develop and embed. It will therefore be important to establish whether or not the evolution in services since 2012–14, when the cohort was recruited, improves quality of life and other patient-reported and clinical outcomes.
Future work
A determination of whether or not the SOME group has similar or improved quality of life and other patient-reported and clinical outcomes in current teenage and young adult service delivery is essential if principal treatment centres for teenagers and young adults are being commissioned to provide ‘joint care’ models with other providers.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- National Cancer Research Institute, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Stark
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group. Cancers (Basel) 2021; 13:cancers13215270. [PMID: 34771435 PMCID: PMC8582416 DOI: 10.3390/cancers13215270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Adolescent and young adult cancer survivors face several significant physical/mental health late effects following cancer treatment. These effects may be minimized through healthcare use tailored to young survivors’ needs. Using a cross-sectional study design, we examined the healthcare use of 93 adolescent/young adult cancer survivors (aged 15–39 years), relative to a comparison group of adolescents and young adults recruited from the local community (n = 183). Our cancer survivor group reported greater use of medical and mental health services, and medications during the past six months relative to the comparison group. Our cancer survivor group also reported less psychological distress, and similar work/study participation relative to the comparison group. Survivors who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater healthcare use. Future research is needed to determine whether the healthcare accessed by adolescent and young adult cancer survivors is appropriate and meets their needs. Abstract Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.
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9
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Patterson P, D'Agostino NM, McDonald FEJ, Church TD, Costa DSJ, Rae CS, Siegel SE, Hu J, Bibby H, Stark DP. Screening for distress and needs: Findings from a multinational validation of the Adolescent and Young Adult Psycho-Oncology Screening Tool with newly diagnosed patients. Psychooncology 2021; 30:1849-1858. [PMID: 34160847 PMCID: PMC9291177 DOI: 10.1002/pon.5757] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) diagnosed with cancer commonly experience elevated psychological distress and need appropriate detection and management of the psychosocial impact of their illness and treatment. This paper describes the multinational validation of the Distress Thermometer (DT) for AYAs recently diagnosed with cancer and the relationship between distress and patient concerns on the AYA-Needs Assessment (AYA-NA). METHODS AYA patients (N = 288; 15-29 years, Mage = 21.5 years, SDage = 3.8) from Australia (n = 111), Canada (n = 67), the UK (n = 85) and the USA (n = 25) completed the DT, AYA-NA, Hospital Anxiety Depression Scale (HADS) and demographic measures within 3 months of diagnosis. Using the HADS as a criterion, receiver operating characteristics analysis was used to determine the optimal cut-off score and meet the acceptable level of 0.70 for sensitivity and specificity. Correlations between the DT and HADS scores, prevalence of distress and AYA-NA scores were reported. RESULTS The DT correlated strongly with the HADS-Total, providing construct validity evidence (r = 0.65, p < 0.001). A score of 5 resulted in the best clinical screening cut-off on the DT (sensitivity = 82%, specificity = 75%, Youden Index = 0.57). Forty-two percent of AYAs scored at or above 5. 'Loss of meaning or purpose' was the AYA-NA item most likely to differentiate distressed AYAs. CONCLUSIONS The DT is a valid distress screening instrument for AYAs with cancer. The AYA-POST (DT and AYA-NA) provides clinicians with a critical tool to assess the psychosocial well-being of this group, allowing for the provision of personalised support and care responsive to individuals' specific needs and concerns.
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Affiliation(s)
- Pandora Patterson
- Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Norma M D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Fiona E J McDonald
- Canteen Australia, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Terry David Church
- Regulatory and Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Charlene S Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E Siegel
- Kenneth J. Norris, Jr. Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - James Hu
- Kenneth J. Norris, Jr. Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Helen Bibby
- Canteen Australia, Sydney, New South Wales, Australia
| | - Dan P Stark
- Division of Oncology, Leeds Institute of Medical Research, School of Medicine, The University of Leeds, Leeds, UK
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10
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Patterson P, Allison KR, Bibby H, Thompson K, Lewin J, Briggs T, Walker R, Osborn M, Plaster M, Hayward A, Henney R, George S, Keuskamp D, Anazodo A. The Australian Youth Cancer Service: Developing and Monitoring the Activity of Nationally Coordinated Adolescent and Young Adult Cancer Care. Cancers (Basel) 2021; 13:cancers13112675. [PMID: 34071622 PMCID: PMC8198716 DOI: 10.3390/cancers13112675] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Adolescents and young adults (aged 15-25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016-17 and 2019-20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults.
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Affiliation(s)
- Pandora Patterson
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
| | - Kimberley R. Allison
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
| | - Helen Bibby
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
| | - Kate Thompson
- Victoria/Tasmania Youth Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (K.T.); (J.L.)
- ONTrac at PeterMac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Jeremy Lewin
- Victoria/Tasmania Youth Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (K.T.); (J.L.)
- ONTrac at PeterMac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Taia Briggs
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW 2031, Australia; (T.B.); (A.A.)
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Rick Walker
- Queensland Youth Cancer Service, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (R.W.); (R.H.)
- Oncology Services Group, Children’s Health Queensland, Brisbane, QLD 4000, Australia
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Michael Osborn
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (M.O.); (A.H.)
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, SA 5006, Australia
| | - Meg Plaster
- Western Australia Youth Cancer Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (M.P.); (S.G.)
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Allan Hayward
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (M.O.); (A.H.)
| | - Roslyn Henney
- Queensland Youth Cancer Service, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (R.W.); (R.H.)
| | - Shannyn George
- Western Australia Youth Cancer Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (M.P.); (S.G.)
| | - Dominic Keuskamp
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
| | - Antoinette Anazodo
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW 2031, Australia; (T.B.); (A.A.)
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- School of Women and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW 2031, Australia
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11
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Sansom-Daly UM, Wakefield CE, Ellis SJ, McGill BC, Donoghoe MW, Butow P, Bryant RA, Sawyer SM, Patterson P, Anazodo A, Plaster M, Thompson K, Holland L, Osborn M, Maguire F, O’Dwyer C, De Abreu Lourenco R, Cohn RJ. Online, Group-Based Psychological Support for Adolescent and Young Adult Cancer Survivors: Results from the Recapture Life Randomized Trial. Cancers (Basel) 2021; 13:2460. [PMID: 34070134 PMCID: PMC8158368 DOI: 10.3390/cancers13102460] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022] Open
Abstract
Telehealth interventions offer a practical platform to support adolescent and young adult (AYA) cancer survivors' mental health needs after treatment, yet efficacy data are lacking. We evaluated an online, group-based, videoconferencing-delivered cognitive-behavioral therapy (CBT) intervention ('Recapture Life') in a 3-arm randomized-controlled trial comparing Recapture Life with an online peer-support group, and a waitlist control, with the aim of testing its impact on quality of life, emotional distress and healthcare service use. Forty AYAs (Mage = 20.6 years) within 24-months of completing treatment participated, together with 18 support persons. No groupwise impacts were measured immediately after the six-week intervention. However, Recapture Life participants reported using more CBT skills at the six-week follow-up (OR = 5.58, 95% CI = 2.00-15.56, p = 0.001) than peer-support controls. Recapture Life participants reported higher perceived negative impact of cancer, anxiety and depression at 12-month follow-up, compared to peer-support controls. Post-hoc analyses suggested that AYAs who were further from completing cancer treatment responded better to Recapture Life than those who had completed treatment more recently. While online telehealth interventions hold promise, recruitment to this trial was challenging. As the psychological challenges of cancer survivorship are likely to evolve with time, different support models may prove more or less helpful for different sub-groups of AYA survivors at different times.
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Affiliation(s)
- Ursula M. Sansom-Daly
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Sarah J. Ellis
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Brittany C. McGill
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Mark W. Donoghoe
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, NSW 2033, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW 2050, Australia;
| | | | - Susan M. Sawyer
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia;
- Royal Children’s Hospital Centre for Adolescent Health, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Pandora Patterson
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia;
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Antoinette Anazodo
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Megan Plaster
- Western Australia Youth Cancer Service, Sir Charles Gairdner Hospital, WA 6009, Australia;
| | - Kate Thompson
- Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Department of Social Work, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lucy Holland
- Queensland Child and Youth Clinical Network, Clinical Excellence Queensland, Herston, QLD 4006, Australia;
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Michael Osborn
- Youth Cancer Service SA/NT, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
| | - Fiona Maguire
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
| | - Catherine O’Dwyer
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, NSW 2000, Australia;
| | - Richard J. Cohn
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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12
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van der Haak N, Edwards S, Perem M, Landorf E, Osborn M. Nutritional Status at Diagnosis, During, and After Treatment in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:668-674. [PMID: 33844931 DOI: 10.1089/jayao.2020.0197] [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: 11/12/2022] Open
Abstract
Purpose: Malnutrition is commonly observed during cancer treatment, while some cancer survivors are at risk of overweight and obesity. This study investigated nutritional status during and after treatment in adolescents and young adults (AYA) with cancer. Methods: A retrospective chart review of AYA diagnosed with cancer was conducted. Data were collected monthly during treatment, then annually for 3 years of follow-up. Results: Of 93 AYA, 8% were underweight at diagnosis versus 20% during treatment (p = 0.012). Forty-four percent experienced ≥5% loss of weight (LOW) during treatment, and 23% of those were not referred to a dietitian. While 47% were referred to a dietitian at some point during treatment, 77% did not have dietetic involvement in the month after reaching greatest percentage LOW. Different tumor types were associated with different risks of LOW. Eighty-six percent with acute lymphoblastic leukemia (ALL)/lymphoblastic lymphoma (LL) and 86% with acute myeloid leukemia had ≥5% LOW during treatment, compared with 17% with Hodgkin lymphoma (p < 0.0001). In year 3 of follow-up, 36% of all AYA were overweight or obese versus 25% at diagnosis (p = 0.2). Overweight/obesity was more common in ALL/LL survivors than other tumor types (67% vs. 14%, p = 0.037). No patients had dietitian involvement in year 3 of follow-up. Conclusions: AYA, particularly those with ALL/LL, are at risk of significant weight loss during treatment and overweight and obesity during survivorship. Dietetic involvement was inconsistent in this cohort. These data may guide which diagnoses warrant preemptive dietetic input during treatment and highlight the importance of dietetic involvement in survivorship.
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Affiliation(s)
- Natalie van der Haak
- Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, Data, Design and Statistics Service, School of Public Health, The University of Adelaide, Adelaide, South Australia
| | - Merike Perem
- Youth Cancer Service, Royal Adelaide Hospital, Adelaide, South Australia
| | - Emma Landorf
- Department of Nutrition, Women's and Children's Hospital, North Adelaide, South Australia
| | - Michael Osborn
- Youth Cancer Service, Royal Adelaide Hospital, Adelaide, South Australia.,Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia
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13
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Holland LR, Bradford NK, Youl P, Cossio D, Dunn N, Tran N, Walker R. Cancer Incidence, Mortality, and Survival for Children, Adolescents, and Young Adults in Queensland Between 1987 and 2016. J Adolesc Young Adult Oncol 2020; 10:629-644. [PMID: 33306001 DOI: 10.1089/jayao.2020.0151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Cancer remains the most common cause of disease-related death among young people and carries a significant burden. In the absence of prior state-based Australian epidemiological studies, this retrospective cohort study reviewed all cases of invasive cancer diagnosed in Queensland children, adolescents, and young adults (AYAs) (0-39 years) from 1987 to 2016 using the Queensland Oncology Repository (QOR). Methods: Cancers were classified according to Surveillance, Epidemiology and End Results (SEER) AYA site recode. Age-standardized rates (ASRs) were calculated. JoinPoint regression examined trends in ASRs across three age cohorts, for three decades (1987-1996, 1997-2006, and 2007-2016). Results: In total, 3,576 children aged 0-14 years (ASR = 15.2/100,000), 6,441 aged 15-24 years (ASR = 39.3/100,000), and 29,923 (ASR = 122.6/100,000) aged 25-39 years were diagnosed. Incidence increased for female children, and leukemia was the most common diagnosis. For those 15-24 years, incidence increased initially before decreasing and was higher than other nationally reported rates. For those 25-39 years, incidence increased. For the older cohorts, the most common diagnosis was melanoma. All cohorts demonstrated a decline in mortality and improvement in 5-year relative survival, with those 0-14 years demonstrating the greatest gains. The lowest survival for all cohorts was associated with central nervous system tumors. Conclusion: These results highlight areas in need of further investigation to improve survival, reduce the burden of cancer for young people, and aid service delivery. Future studies should focus on cancer biology, early detection, barriers in access to clinical trials, innovative models of care, improved data collection, and patient-reported outcomes.
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Affiliation(s)
- Lucy R Holland
- Institute of Health and BioMedical Innovation, Queensland University of Technology, Brisbane, Australia.,The University of Newcastle, Newcastle, Australia
| | - Natalie K Bradford
- Institute of Health and BioMedical Innovation at Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Danica Cossio
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Nathan Dunn
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Nancy Tran
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Rick Walker
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia.,Queensland Youth Cancer Service, Children's Health Queensland, Brisbane, Australia.,Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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14
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Vandekerckhove P, de Mul M, de Groot L, Elzevier HW, Fabels B, Haj Mohammad S, Husson O, Noij J, Sleeman SHE, Verbeek D, Von Rosenstiel I, de Bont AA, Manten-Horst E. Lessons for Employing Participatory Design When Developing Care for Young People with Cancer: A Qualitative Multiple-Case Study. J Adolesc Young Adult Oncol 2020; 10:404-417. [PMID: 33185496 PMCID: PMC8388252 DOI: 10.1089/jayao.2020.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Participatory design (PD) is a collective creative design process involving designers and nondesigners. There is limited reporting on the experience of using PD for adolescent and young adult (AYA) care. This study summarizes lessons from employing PD to develop care for AYAs with cancer. Methods: A qualitative multiple-case study method was conducted of three PD processes addressing food (FfC), intimacy and sexuality (I&S), and integrative medicine (IM) in caring for AYAs with cancer. Results: Local key stakeholders, who were exposed to a problem and had not been successful at solving it individually, were recruited to “dream” together. Through this synergy, a shared understanding of the problem and a joint mission emerged to find a solution. PD tools were used to develop a problem definition. An open mind and explorative research helped to understand the problems, and stakeholders were managed such that idea-sharing and learning were enabled. Designers translated ideas into prototypes. The PD process was prolonged due to the hierarchical hospital environment, business considerations, and additionally required evidence. The FfC program produced an effective new food service for the whole hospital. The I&S initiative developed a podcast, two articles, and a prototype website. The IM project developed a pilot study. Conclusions: For a PD process to successfully develop care for AYAs, one needs to use designers and skilled people, PD tools, and an open-ended approach to visualize and materialize new forms of care. Furthermore, recruitment and facilitation techniques help leverage knowledge and create a synergy in a democratic environment between stakeholders.
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Affiliation(s)
- Pieter Vandekerckhove
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marleen de Mul
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Henk W Elzevier
- Department of Urology and Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Soemeya Haj Mohammad
- Department of Urology and Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Olga Husson
- Department of Medical Oncology and Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Julian Noij
- Dutch AYA Care Network, Utrecht, The Netherlands
| | | | | | | | - Antoinette A de Bont
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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15
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Harrup R, White VM, Coory M, Walker R, Anazodo A, Skaczkowski G, Bibby H, Osborn M, Phillips MB, Conyers R, Thompson K, Orme LM, Pinkerton R, Nicholls W. Treatment and Outcomes for Central Nervous System Tumors in Australian Adolescents and Young Adults: A Population-Based National Study. J Adolesc Young Adult Oncol 2020; 10:202-208. [PMID: 32856982 DOI: 10.1089/jayao.2020.0074] [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
Purpose: While central nervous system (CNS) tumors account for only 10% of adolescent and young adult (AYA) cancers, they are the leading cause of cancer death in this age group. Using national data for Australia, we describe the presentation, treatment, and survival for AYAs diagnosed with CNS tumors. Methods: A population-based study of 15-24 year-olds diagnosed with CNS tumors (low- and high-grade glioma [LGG, HGG], medulloblastoma [MB], primitive neuroectodermal tumors [PNET], ependymoma [EP]) or other (e.g., low-grade neuronal tumor) between 2007 and 2012. Clinical details were extracted from hospital medical records for each patient. Treatment centers were classified as pediatric or adult services. Results: Two hundred seventy-five patients (129 LGG, 77 HGG, 23 MB, 10 PNET, 19 EP, 17 other) were identified, with 17% treated at pediatric hospitals. Symptoms (headache [53%], nausea [31%]) were present for a median of 3 weeks before consulting a health professional. Of LGG patients, 15% had radiotherapy (RT) and 12% chemotherapy (CT). Of HGG patients, 81% had RT and 75% CT. All MB and PNET were managed with surgery, and 74% of MB and 80% of PNET had both RT and CT. Treatment did not differ by treatment center type. Five-year survival for LGG and EP was over 80%, but was 42% for HGG and 20% for PNET. Conclusions: This national, population-based study indicates similar treatment for AYA patients with CNS tumors between pediatric and adult services. Poor outcomes for HGG and PNET patients highlight the need for clinical trials of novel approaches for these tumors.
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Affiliation(s)
- Rosemary Harrup
- Medical Oncology/Haematology, Royal Hobart Hospital, Tasmania, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Victoria, Australia.,Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Michael Coory
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Rick Walker
- Oncology Services Group, Queensland Children's Hospital, Queensland, Australia.,Oncology Unit, Princess Alexandra Hospital, Queensland, Australia.,School of Medicine, University of Queensland, Queensland, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Australia
| | - Gemma Skaczkowski
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia.,Department of Rural Health, Allied Health and Human Performance, University of South Australia, Australia
| | - Helen Bibby
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Michael Osborn
- Youth Cancer Service, Royal Adelaide Hospital, South Australia, Australia.,Department of Haematology and Oncology, Women's and Children's Hospital, South Australia, Australia
| | - Marianne B Phillips
- Oncology, Haematology & Bone Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Rachel Conyers
- Children's Cancer Centre, The Royal Children's Hospital, Victoria, Australia
| | - Kate Thompson
- Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Lisa M Orme
- Children's Cancer Centre, The Royal Children's Hospital, Victoria, Australia
| | - Ross Pinkerton
- Hummingbird House Children's Hospice, Brisbane, Australia
| | - Wayne Nicholls
- Oncology Services Group, Queensland Children's Hospital, Queensland, Australia.,School of Medicine, University of Queensland, Queensland, Australia
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16
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Holland LR, Walker R, Henney R, Cashion CE, Bradford NK. Adolescents and Young Adults with Cancer: Barriers in Access to Psychosocial Support. J Adolesc Young Adult Oncol 2020; 10:46-55. [PMID: 32486879 DOI: 10.1089/jayao.2020.0027] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) experience cancer at a time of significant developmental transition. Both disease and treatment impact psychosocial well-being in significant, persistent ways. While the impacts are now described, and the need for psychosocial care is increasingly well recognized, to date, the barriers in access to care have not been well delineated. This is essential to understand to facilitate access to appropriate care and improve outcomes. Methods: This study explored the barriers in access to psychosocial care for young people. Semistructured, audio-recorded interviews were undertaken with 16 AYAs aged 15-25 years. Eligible participants were diagnosed within the previous 24 months and recruited through the Queensland Youth Cancer Service (QYCS). Transcribed interviews were analyzed using content analysis. Results: Barriers in access to support were related to person-centered, service-related, and systemic factors. Barriers experienced at diagnosis and during treatment were less common compared with barriers after treatment; these were significant and largely related to a lack of holistic, multidisciplinary survivorship care. Conclusion: Barriers in access to psychosocial care are multifactorial, although most can be addressed through health-service responses. Ensuring standardized referral and repeated introduction of psychosocial care for young people is imperative, regardless of location of treatment. Flexible services are especially important for patients treated across different facilities. The development of comprehensive post-treatment survivorship models of care is also essential. Continued evaluation of the experience of young people and the barriers they face is also crucial to ensure responsive service development and promote optimal care.
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Affiliation(s)
- Lucy R Holland
- School of Nursing, Queensland University of Technology, Brisbane, Australia.,Department of Social Work, Welfare and Indigenous Liaison, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia.,Faculty of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Rick Walker
- Queensland Youth Cancer Service, Children's Health Queensland, Brisbane, Australia.,Oncology Services Group, Children's Health Queensland, Brisbane, Australia.,Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Australia
| | - Roslyn Henney
- Queensland Youth Cancer Service, Children's Health Queensland, Brisbane, Australia
| | - Christine E Cashion
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Natalie K Bradford
- Queensland University of Technology (QUT), Centre for Healthcare Transformation and School of Nursing at Centre for Children's Health Research, Brisbane, Australia
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17
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Gupta S, Baxter NN, Hodgson D, Punnett A, Sutradhar R, Pole JD, Nagamuthu C, Lau C, Nathan PC. Treatment patterns and outcomes in adolescents and young adults with Hodgkin lymphoma in pediatric versus adult centers: An IMPACT Cohort Study. Cancer Med 2020; 9:6933-6945. [PMID: 32441450 PMCID: PMC7541154 DOI: 10.1002/cam4.3138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 12/26/2022] Open
Abstract
Hodgkin lymphoma (HL) is a common adolescent and young adult (AYA) cancer. While outcome disparities between pediatric vs. adult centers [locus of care (LOC)] have been demonstrated in other AYA cancers such as acute lymphoblastic leukemia, they have not been well studied in HL. We therefore compared population‐based treatment patterns and outcomes in AYA HL by LOC. The IMPACT Cohort includes data on all Ontario, Canada AYA (15‐21 years) diagnosed with HL between 1992 and 2012. Linkage to population‐based health administrative data identified late effects. We examined LOC‐based differences in treatment modalities, cumulative doses, event‐free survival (EFS), overall survival (OS), and late effects. Among 954 AYA, 711 (74.5%) received therapy at adult centers. Pediatric center AYA experienced higher rates of radiation therapy but lower cumulative doses of doxorubicin and bleomycin. 10‐year EFS did not differ between pediatric vs. adult cancer vs. community centers (83.8% ± 2.4% vs. 82.8% ± 1.6% vs. 82.7%±3.0%; P = .71); LOC was not significantly associated with either EFS or OS in multivariable analyses. Higher incidences of second malignancies in pediatric center AYA and of cardiovascular events in adult center AYA were observed, but were not significant. In conclusion, while pediatric and adult centers used different treatment strategies, outcomes were equivalent. Differences in treatment exposures are however likely to result in different late‐effect risks. Protocol choice should be guided by individual late‐effect risk.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada
| | - Nancy N Baxter
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - David Hodgson
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Angela Punnett
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada
| | - Rinku Sutradhar
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada.,Center for Health Services, The University of Queensland, Brisbane, Australia
| | - Chenthila Nagamuthu
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Cindy Lau
- Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Research Program, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, ON, Canada
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18
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Dax V, Edwards N, Doidge O, Morkunas B, Thompson K, Lewin J. Evaluation of an Educational and Vocational Service for Adolescent and Young Adults with Cancer: A Retrospective Review. J Adolesc Young Adult Oncol 2020; 10:56-65. [PMID: 32392441 DOI: 10.1089/jayao.2020.0009] [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: 10/24/2022] Open
Abstract
Purpose: A cancer diagnosis and its treatment has the potential to interfere with the ability of adolescent and young adults (AYAs) to remain engaged in education or employment, placing social connectivity, career progression, and financial security at risk. This study aimed at assessing the educational and vocational outcomes of AYAs supported by an Education and Vocational Support Program (EVSP). Methods: Consecutive case files were reviewed of AYAs accessing the EVSP at ONTrac at Peter Mac (January 2014-December 2016). Data collected included: demographic information; diagnosis and treatment; referral time point; education/employment status at referral and end of treatment; and interventions provided. Results: Two hundred nineteen AYAs had >1 appointment with an EVSP advisor. The mean age was 19.6 (13-26). The most common intervention delivered was direct consultations. Overall, 79% of AYAs were engaged in educational and/or vocational pursuits at last known status. Engagement with EVSP during treatment for employment and tertiary educational support had a high rate of attendance at last known status (during treatment: 93% and 92.5%; post-treatment: 71% and 69%, respectively). At referral to EVSP, 27 AYAs were not in education, employment, or training; however, >50% re-integrated in employment or study after EVSP support. Conclusion: This is the first study to describe the role of an EVSP for Australian AYAs. With the support of an EVSP, the vast majority of AYAs remained engaged in education and/or employment throughout their cancer trajectory. Further research will be required to evaluate the quality of interventions and incorporate the voice of AYAs to further inform service delivery.
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Affiliation(s)
- Victoria Dax
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicole Edwards
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Olivia Doidge
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Bryce Morkunas
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Social Work and The University of Melbourne, Melbourne, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
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19
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Evolving Services for Adolescents with Cancer in Italy: Access to Pediatric Oncology Centers and Dedicated Projects. J Adolesc Young Adult Oncol 2020; 9:196-201. [DOI: 10.1089/jayao.2019.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Rae C, Shah N, De Pauw S, Costa A, Barr RD. System Performance Indicators for Adolescent and Young Adult Cancer Care and Control: A Scoping Review. J Adolesc Young Adult Oncol 2020; 9:1-11. [DOI: 10.1089/jayao.2019.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nishwa Shah
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonja De Pauw
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Costa
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronald D. Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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21
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Do specialist youth cancer services meet the physical, psychological and social needs of adolescents and young adults? A cross sectional study. Eur J Oncol Nurs 2020; 44:101709. [DOI: 10.1016/j.ejon.2019.101709] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/15/2019] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
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22
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Osborn M, Johnson R, Thompson K, Anazodo A, Albritton K, Ferrari A, Stark D. Models of care for adolescent and young adult cancer programs. Pediatr Blood Cancer 2019; 66:e27991. [PMID: 31524328 DOI: 10.1002/pbc.27991] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/30/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022]
Abstract
This review draws on the experience of adolescent and young adult (AYA) cancer clinicians from Australia, the United States, and the United Kingdom to summarize common aspects of models of care implemented in their countries. The principles underpinning these models include patient- and family-focused care informed by an understanding of normal AYA development, enhancing existing adult or pediatric cancer services to meet the needs of AYA, and promoting collaboration between pediatric and adult oncologists. Common elements of AYA cancer care include establishing an AYA multidisciplinary team that integrates medical and psychosocial care, efforts to centralize complex care, providing access and equity for all AYA, promoting clinical trials, and helping facilitate transition to healthy survivorship. Several organizational approaches are described, noting that local program development depends on resources, infrastructure, and assessment of unmet needs within the region. The development of national networks provides opportunities for shared learning and approaches to evaluation.
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Affiliation(s)
- Michael Osborn
- Youth Cancer Service SA/NT, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Rebecca Johnson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Adolescent and Young Adult Oncology Program, Mary Bridge Children's Health Center/MultiCare Health System, Tacoma, Washington
| | - Kate Thompson
- OnTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Karen Albritton
- Adolescent and Young Adult Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Daniel Stark
- The Leeds Institute of Cancer and Pathology, Leeds Institute of Oncology and St James's University Hospital, Leeds, UK
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23
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McNeil R, Egsdal M, Drew S, McCarthy MC, Sawyer SM. The changing nature of social support for adolescents and young adults with cancer. Eur J Oncol Nurs 2019; 43:101667. [PMID: 31586646 DOI: 10.1016/j.ejon.2019.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 08/22/2019] [Accepted: 09/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to explore adolescent and young adult (AYA) experiences and preferences for social support early within the continuum of cancer treatment. METHODS AYAs aged 15-25 years old at diagnosis were recruited from 6 clinical services that were purposively selected for providing specialist cancer care to AYAs across 3 Australian states and within paediatric and adult services. In-depth, semi-structured interviews were conducted by telephone 6-24 months from diagnosis. The narrative-based interviews included preferences for psychosocial support. Interviews were transcribed and thematic analysis was undertaken using grounded theory methodology. RESULTS 60 AYAs were interviewed (mean age 20.52 [SD 2.97] years; 58% male; 72% adult settings). Analysis revealed that parents provided the foundation of emotional, informational and instrumental social support, even for older AYAs and those with partners and children. Informal emotional engagement with cancer peers was strongly appreciated during hospital treatment, while healthy peers provided welcome diversion at this time and during the transition towards their usual life. Nurses and allied health staff provided informational support to hospitalised AYAs and also provided a strong source of emotional support. Formal peer support programs were not endorsed by AYAs early in treatment but appreciated to be of greater interest to some following treatment completion. CONCLUSION Social support was predominantly provided by family, peers and health professionals. The sources and types of support most welcomed by AYAs varied according to the intensity and phase of cancer treatment and where the young person was in their cancer trajectory.
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Affiliation(s)
- Robyn McNeil
- Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Centre for Adolescent Health, Melbourne, Australia.
| | - Mette Egsdal
- Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Centre for Adolescent Health, Melbourne, Australia; Department of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Sarah Drew
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Australia; Royal Children's Hospital, Centre for Adolescent Health, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia
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24
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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.
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25
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White VM, Orme LM, Skaczkowski G, Pinkerton R, Coory M, Osborn M, Bibby H, Nicholls W, Conyers R, Phillips MB, Harrup R, Walker R, Thompson K, Anazodo A. Management of Sarcoma in Adolescents and Young Adults: An Australian Population-Based Study. J Adolesc Young Adult Oncol 2019; 8:272-280. [PMID: 30822262 DOI: 10.1089/jayao.2018.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: While overall survival (OS) for cancer in adolescents and young adults (AYA) has improved, there has been little change in AYA survival for several types of sarcomas. Using national data for Australia we describe (1) the treatment centers caring for AYA sarcoma, (2) treatments provided, and (3) survival outcomes. Procedure: National population-based study assessing treatment of 15-24 year-olds diagnosed with soft tissue sarcoma (STS), bone sarcoma (BS), and Ewing family tumors (ET) between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult specialist AYA/sarcoma center, or other adult. Cox proportional hazard regression analyses examined associations between type of treatment center and OS. Results: Sixty-one hospitals delivered treatment to 318 patients (135 STS; 91 BS, 92 ET), with 9%, 22%, and 17% of STS, BS, and ET, respectively, treated at pediatric and 62%, 59%, and 71% at adult specialist hospitals. Of 18-24 year-olds, 82% of BS, 90% of ET, and 73% of rhabdomyosarcomas at adult specialist centers were on a trial or standard protocol, compared with 42%, 89%, and 100%, respectively, at nonspecialist adult hospitals. After adjusting for disease and patient characteristics, survival was not associated with treatment center type for any disease type. However, ET survival was poorer for patients not receiving a standard chemotherapy protocol. Conclusions: Around 10% of AYA sarcoma patients attending adult hospitals were not on a standard protocol. Poorer survival for ET patients not on a standard protocol highlights the importance of ensuring all patients receive optimal care.
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Affiliation(s)
- Victoria M White
- 1 Center for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,2 School of Psychology, Deakin University, Melbourne, Australia
| | - Lisa M Orme
- 3 Children's Cancer Center, The Royal Children's Hospital, Melbourne, Australia.,4 Peter MacCallum Cancer Center, Melbourne, Australia
| | - Gemma Skaczkowski
- 1 Center for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,5 School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,6 Olivia Newton-John Cancer Wellness & Research Center, Austin Health, Heidelberg, Australia
| | - Ross Pinkerton
- 7 Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Michael Coory
- 3 Children's Cancer Center, The Royal Children's Hospital, Melbourne, Australia
| | | | - Helen Bibby
- 1 Center for Behavioral Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Wayne Nicholls
- 7 Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Rachel Conyers
- 3 Children's Cancer Center, The Royal Children's Hospital, Melbourne, Australia.,4 Peter MacCallum Cancer Center, Melbourne, Australia
| | | | | | - Rick Walker
- 7 Children's Health Queensland Hospital and Health Service, Brisbane, Australia.,11 Princess Alexandra Hospital, Brisbane, Australia
| | - Kate Thompson
- 4 Peter MacCallum Cancer Center, Melbourne, Australia
| | - Antoinette Anazodo
- 12 Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia.,13 Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Randwick, Australia.,14 School of Women's and Children's Health, University of New South Wales, Kensington, Australia
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26
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White VM, Skaczkowski G, Pinkerton R, Coory M, Osborn M, Bibby H, Nicholls W, Orme LM, Conyers R, Phillips MB, Harrup R, Walker R, Thompson K, Anazodo A. Clinical management of Australian adolescents and young adults with acute lymphoblastic and myeloid leukemias: A national population-based study. Pediatr Blood Cancer 2018; 65:e27349. [PMID: 30039912 DOI: 10.1002/pbc.27349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND While several studies have examined the treatment of adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL), studies of acute myeloid leukemia (AML) are rare. Using national data for Australia, we describe (i) the number and type of treatment centers caring for AYAs, (ii) induction/first-line treatments, and (iii) survival outcomes. PROCEDURE National population-based study assessing treatment of 15- to 24-year-olds diagnosed with ALL or AML between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult (adult AYA-focused or other adult; and by AYA volume [high/low]). Cox proportional hazard regression analyses examined associations between treatment and overall, event-free, and relapse-free survival outcomes. RESULTS Forty-seven hospitals delivered induction therapy to 351 patients (181 ALL and 170 AML), with 74 (21%) treated at pediatric centers; 70% of hospitals treated less than two AYA leukemia patients per year. Regardless of treatment center, 82% of ALL patients were on pediatric protocols. For AML, pediatric protocols were not used in adult centers, with adult centers using a non-COG 7+3-type induction protocol (51%, where COG is Cooperative Oncology Group) or an ICE-type protocol (39%, where ICE is idarubicin, cytarabine, etoposide). Exploratory analyses suggested that for both ALL and AML, AYAs selected for adult protocols have worse overall, event-free, and relapse-free survival outcomes. CONCLUSIONS Pediatric protocols were commonly used for ALL patients regardless of where they are treated, indicating rapid assimilation of recent evidence by Australian hematologists. For AML, pediatric protocols were only used at pediatric centers. Further investigation is warranted to determine the optimal treatment approach for AYA AML patients.
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Affiliation(s)
- V M White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - G Skaczkowski
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - R Pinkerton
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - M Coory
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Osborn
- Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - H Bibby
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - W Nicholls
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - L M Orme
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - R Conyers
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M B Phillips
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - R Harrup
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - R Walker
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - K Thompson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
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27
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Introduction by the Guest Editor: Ronald Barr. Cancer J 2018; 24:255. [DOI: 10.1097/ppo.0000000000000342] [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]
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28
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Sawyer SM, McNeil R, Thompson K, Orme LM, McCarthy M. Developmentally appropriate care for adolescents and young adults with cancer: how well is Australia doing? Support Care Cancer 2018; 27:1783-1792. [PMID: 30155569 DOI: 10.1007/s00520-018-4420-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Developmentally appropriate care underpins quality cancer treatment. This study aimed to describe how well Australian cancer services deliver patient-focussed, developmentally appropriate care to adolescents and young adults (AYAs) with cancer. METHODS In a national, cross sectional study, 196 AYAs with cancer aged between 15 and 25 years at diagnosis reported their general experiences of the cancer care team (Cancer Needs Questionnaire), access to age-appropriate treatment environments (Cancer Needs Questionnaire) and frequency of psychosocial assessment (Adolescent Friendly Hospital Survey). RESULTS Very positive responses were reported around engagement and communication with staff who were reported as approachable, friendly and trustworthy; 11 of the 14 items were positively rated by over 90% of respondents. In contrast, over 70% of AYAs expressed unmet need around their physical and social environments, whether in relation to the opportunity to be nursed in wards designed for AYAs, spend time with other young people with cancer, or talk to young people their own age; less than a third reported their needs had been met on the majority of these items. The frequency that specific psychosocial assessment domains were discussed was highly variable; responses suggested that AYAs were less commonly questioned about overtly sensitive topics. AYAs who experienced private consultations with health care providers (41%) were significantly more likely to experience thorough psychosocial assessment. CONCLUSION Australian cancer services are generally communicating well with AYAs. There is room for improvement around more developmentally specific aspects of healthcare quality, such as psychosocial assessment, and around treatment environments that promote greater social interaction between AYAs.
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Affiliation(s)
- S M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
| | - R McNeil
- Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - K Thompson
- Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, VIC, Australia
| | - L M Orme
- Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, VIC, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, VIC, Australia
| | - M McCarthy
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, VIC, Australia
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29
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Bradford NK, Henney R, Walker R, Walpole E, Kennedy G, Nicholls W, Pinkerton R. Queensland Youth Cancer Service: A Partnership Model to Facilitate Access to Quality Care for Young People Diagnosed with Cancer. J Adolesc Young Adult Oncol 2018; 7:339-348. [PMID: 29746187 DOI: 10.1089/jayao.2017.0080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Global recognition of the need to improve outcomes for adolescents and young adults (AYA) with cancer has led to the development of specific oncology programs and services. In Australia, Youth Cancer Services (YCS) are now established across the country. While each service has been shaped by nationally agreed principles, program development has been influenced by local policy and geographic differences. Queensland is a vast state with a widely dispersed population; coordination of cancer services for young people across this landscape presents unique challenges. The Queensland YCS (QYCS) work in a consultative partnership model with primary treating teams, across both pediatric and adult tertiary cancer services. Understanding how cancer services approach challenges and service development can provide guidance for other developing services. In this article, we describe the goals and development of QYCS and review the outcomes achieved in the service to date. We reviewed referral data and retrieved statewide clinical activity from the web-based data system. We compared these data with cancer registry data to identify disparities and areas for service development. While the service has achieved notable outcomes, challenges remain. These include recruitment of appropriately skilled and trained health professionals for this newly developing area of oncology. In addition, there is an ongoing need to advocate for this relatively small patient group, and to promote awareness and understanding of the need for AYA-specific services. With the dispersed population and concentration of services in metropolitan Brisbane, identifying and testing new innovative models, including telehealth, to reach all AYA diagnosed with cancer regardless of location of care are priorities.
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Affiliation(s)
- Natalie K Bradford
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia .,2 School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, Australia
| | - Roslyn Henney
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia
| | - Rick Walker
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia .,3 Oncology Services Group , Children's Health Queensland, Brisbane, Australia .,4 School of Medicine, The University of Queensland , Brisbane, Australia
| | - Euan Walpole
- 4 School of Medicine, The University of Queensland , Brisbane, Australia .,5 Cancer Services, Princess Alexandra Hospital , Brisbane, Queensland, Australia
| | - Glen Kennedy
- 4 School of Medicine, The University of Queensland , Brisbane, Australia .,6 Cancer Care Services, Royal Brisbane and Women's Hospital , Brisbane, Australia
| | - Wayne Nicholls
- 3 Oncology Services Group , Children's Health Queensland, Brisbane, Australia .,4 School of Medicine, The University of Queensland , Brisbane, Australia
| | - Ross Pinkerton
- 3 Oncology Services Group , Children's Health Queensland, Brisbane, Australia .,4 School of Medicine, The University of Queensland , Brisbane, Australia
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Fardell JE, Patterson P, Wakefield CE, Signorelli C, Cohn RJ, Anazodo A, Zebrack B, Sansom-Daly UM. A Narrative Review of Models of Care for Adolescents and Young Adults with Cancer: Barriers and Recommendations. J Adolesc Young Adult Oncol 2018; 7:148-152. [DOI: 10.1089/jayao.2017.0100] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Joanna E. Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Pandora Patterson
- Department of Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Richard J. Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Antoinette Anazodo
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Bradley Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | - Ursula M. Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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Skaczkowski G, White V, Thompson K, Bibby H, Coory M, Pinkerton R, Orme LM, Conyers R, Phillips MB, Osborn M, Harrup R, Anazodo A. Do Australian adolescents' and young adults' experiences of cancer care influence their quality of life? Psychooncology 2018; 27:990-997. [DOI: 10.1002/pon.4625] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/13/2017] [Accepted: 12/15/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Gemma Skaczkowski
- Centre for Behavioural Research in Cancer; Cancer Council Victoria; Melbourne Victoria Australia
- School of Psychology and Public Health; La Trobe University; Melbourne Victoria Australia
- Olivia Newton-John Cancer Wellness & Research Centre; Austin Health; Heidelberg Victoria Australia
| | - Victoria White
- Centre for Behavioural Research in Cancer; Cancer Council Victoria; Melbourne Victoria Australia
- School of Psychology; Deakin University; Melbourne Victoria Australia
| | - Kate Thompson
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Helen Bibby
- Centre for Behavioural Research in Cancer; Cancer Council Victoria; Melbourne Victoria Australia
| | - Michael Coory
- Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - Ross Pinkerton
- Children's Health Queensland Hospital and Health Service; South Brisbane Queensland Australia
| | - Lisa M. Orme
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Children's Cancer Centre; The Royal Children's Hospital; Melbourne Victoria Australia
| | - Rachel Conyers
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Children's Cancer Centre; The Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Parkville Victoria Australia
| | | | - Michael Osborn
- Royal Adelaide Hospital; Adelaide South Australia Australia
| | | | - Antoinette Anazodo
- Kids Cancer Centre; Sydney Children's Hospital; Randwick New South Wales Australia
- Nelune Comprehensive Cancer Centre; Prince of Wales Hospital; Randwick New South Wales Australia
- School of Women's and Children's Health; University of New South Wales; Sydney Australia
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White V, Skaczkowski G, Thompson K, Bibby H, Coory M, Pinkerton R, Nicholls W, Orme LM, Conyers R, Phillips MB, Osborn M, Harrup R, Anazodo A. Experiences of Care of Adolescents and Young Adults with Cancer in Australia. J Adolesc Young Adult Oncol 2018; 7:315-325. [PMID: 29356588 DOI: 10.1089/jayao.2017.0104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To examine the care experiences of Australian Adolescents and Young Adults (AYAs) with cancer during a period when youth cancer services (YCS) were developing across the country. METHODS A cross-sectional, self-report survey completed by 207 recently diagnosed AYAs with cancer, recruited from the population-based cancer registries of Australia's two most populous states. AYAs were 15 to 24 years old when diagnosed with any form of cancer (except melanoma <3 mm or stage I/II). Respondents indicated whether certain events/experiences occurred at various points along the cancer care pathway and the treatment centers attended. Treatment centers with YCS were identified. RESULTS Participating AYAs were an average of 9 months post-diagnosis. AYAs were treated in over 60 centers, with only 31% attending YCS. While experiences relating to delivery of treatment were generally positive, supportive care experiences and emotional support were missing for many. Information provision at the end of treatment was low, with 60% not receiving a treatment summary and 50% not receiving a written follow-up care plan. In addition, 42% never/rarely received information relevant to their age, and only 54% reported that healthcare professionals definitely checked their understanding of the information provided. AYAs attending YCS were more likely to report age-appropriate treatment settings, information provision, and emotional support. CONCLUSION While care experiences were generally positive for most AYAs, attending YCS was associated with better communication and supportive care experiences. As only a third of the AYAs surveyed attended these services, efforts are needed to increase AYA access to YCS.
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Affiliation(s)
- Victoria White
- 1 Centre for Behavioural Research in Cancer , Cancer Council Victoria, Victoria, Australia .,2 School of Psychology, Deakin University , Victoria, Australia
| | - Gemma Skaczkowski
- 1 Centre for Behavioural Research in Cancer , Cancer Council Victoria, Victoria, Australia .,3 School of Psychology and Public Health, La Trobe University , Victoria, Australia .,4 Olivia Newton-John Cancer Wellness and Research Centre , Austin Health, Victoria, Australia
| | - Kate Thompson
- 5 Peter MacCallum Cancer Centre , Victoria, Australia
| | - Helen Bibby
- 1 Centre for Behavioural Research in Cancer , Cancer Council Victoria, Victoria, Australia
| | - Michael Coory
- 6 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Victoria, Australia
| | - Ross Pinkerton
- 7 Children's Health Queensland Hospital and Health Service , Queensland, Australia
| | - Wayne Nicholls
- 7 Children's Health Queensland Hospital and Health Service , Queensland, Australia
| | - Lisa M Orme
- 5 Peter MacCallum Cancer Centre , Victoria, Australia .,8 Children's Cancer Centre, The Royal Children's Hospital , Victoria, Australia
| | - Rachel Conyers
- 5 Peter MacCallum Cancer Centre , Victoria, Australia .,8 Children's Cancer Centre, The Royal Children's Hospital , Victoria, Australia .,9 Murdoch Children's Research Institute , Victoria, Australia
| | | | | | | | - Antoinette Anazodo
- 13 Kids Cancer Centre, Sydney Children's Hospital , New South Wales, Australia .,14 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital , New South Wales, Australia .,15 School of Women's and Children's Health University of New South Wales , New South Wales, Australia
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Ferrari A, Barr RD. International evolution in AYA oncology: Current status and future expectations. Pediatr Blood Cancer 2017; 64. [PMID: 28370975 DOI: 10.1002/pbc.26528] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 01/22/2023]
Abstract
Adolescents and Young Adults (AYAs) contribute approximately 1 million incident cases globally, but the great majority are underserved. In high-income countries, overall survival exceeds 80%, but the needs of this population during and after their treatment experience are poorly met, though specialized clinical programs are evolving. Engagement of national governments is advantageous and deployment of multidisciplinary teams essential. Collaboration between pediatric and adult healthcare providers is mandatory and AYAs must be given a strong voice in program development. Building and sharing international experience will hasten advances in clinical care, education, and research, while a focus on developing countries is a worthy challenge.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nationale dei Tumori, Milan, Italy
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
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Bleyer A, Ferrari A, Whelan J, Barr RD. Global assessment of cancer incidence and survival in adolescents and young adults. Pediatr Blood Cancer 2017; 64. [PMID: 28244694 DOI: 10.1002/pbc.26497] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 01/01/2023]
Abstract
In high-income countries, cancer remains the commonest cause of disease-related death in adolescents and young adults (AYAs) despite survival improvements. With more than 1,000,000 new diagnoses of cancer in AYAs annually worldwide, and their number of life-years affected by cancer being greatest of all ages, the global burden of cancer in AYAs exceeds that in all other ages. In low- and middle-income countries, where the great majority of the world's 3 billion AYAs reside, the needs of those with cancer have been identified and demand attention. Unique to the age group but universal, the psychosocial challenges they face are the utmost across life's spectrum. This lead-off article of a new series in Pediatric Blood and Cancer on AYA oncology attempts to assess the global status of this emerging discipline. The review includes the changing incidence and survival of the common cancers in AYAs-there is no other age group with a similar array of malignancies-and the specific challenges to quality and quantity of life that compromise their lives.
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Affiliation(s)
- Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Sciences University, Portland, Oregon.,Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas
| | - Andrea Ferrari
- Division of Medicine, Istituto Nazionale per lo Studio e la Cura dei Tumori di Milano, Milan, Italy
| | - Jeremy Whelan
- Department of Oncology, UCL Hospitals NHS Foundation Trust, London, UK
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Ontario, Canada
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Lang MJ, Giese-Davis J, Patton SB, Campbell DJ. Does age matter? Comparing post-treatment psychosocial outcomes in young adult and older adult cancer survivors with their cancer-free peers. Psychooncology 2017; 27:1404-1411. [DOI: 10.1002/pon.4490] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/25/2017] [Accepted: 06/26/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Michael J. Lang
- Department of Community Health Sciences, Cumming School of Medicine (CSM); University of Calgary (UofC); Calgary Canada
| | - Janine Giese-Davis
- Department of Community Health Sciences, Cumming School of Medicine (CSM); University of Calgary (UofC); Calgary Canada
- Department of Oncology; CSM, UofC; Calgary Canada
| | - Scott B. Patton
- Department of Community Health Sciences, Cumming School of Medicine (CSM); University of Calgary (UofC); Calgary Canada
- Department of Psychiatry; CSM, UofC; Calgary Canada
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38
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Kim B, White K, Patterson P. Understanding the experiences of adolescents and young adults with cancer: A meta-synthesis. Eur J Oncol Nurs 2016; 24:39-53. [PMID: 27697276 DOI: 10.1016/j.ejon.2016.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE To conduct a meta-synthesis of qualitative studies exploring experiences of young cancer patients to identify the overarching concepts that inform future service and research directions. METHOD A systematic literature search was conducted, and 51 articles published between January 2004 and March 2014 were collected via CINAHL, Medline and PsycINFO databases. Deductive thematic analysis was conducted to identify major themes, guided by Hermeneutic notions on interpretation. RESULTS Cancer impacted a wide range of life domains. These impacts were interconnected and bi-directional. The meanings of these impacts were closely related to their unique developmental needs and a social position as youth. Emotional struggles during these radical changes were evident, but efforts to make sense of their experiences and find meaning pervaded. CONCLUSIONS Given the interrelated nature of the cancer challenges young cancer patients experience, there needs to be an emphasis on conducting studies which further refine our understanding of these relationships. This can help to structure effective youth cancer services. Generic informational resources and support services should be tailored so that they have relevance to the young person's life context. The treating team has an important role in fostering young patients' ability to make sense of their experiences by providing developmentally-relevant psychosocial support.
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Affiliation(s)
- Bora Kim
- School of Nursing, The University of Wollongong, Building 41, 215 Northfields Ave, Keiraville, NSW, Australia; Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown NSW, Australia.
| | - Kate White
- Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown NSW, Australia; Cancer Nursing Research Unit, Level 6 North, The Chris O'Brien Life house, 119-143 Missenden Road, Camperdown NSW, Australia
| | - Pandora Patterson
- Cancer Nursing Research Unit, Level 6 North, The Chris O'Brien Life house, 119-143 Missenden Road, Camperdown NSW, Australia; Research & Youth Cancer Services, CanTeen Australia, 75 King Street, Newtown, NSW, Australia
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Sawyer SM, McCarthy MC, Dunt D, McNeil R, Thompson K, Orme L, Drew SE. Fulfilling the Vision of Youth-Friendly Cancer Care: A Study Protocol. J Adolesc Young Adult Oncol 2016; 5:267-77. [DOI: 10.1089/jayao.2015.0050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Susan M. Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Maria C. McCarthy
- Murdoch Childrens Research Institute, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - David Dunt
- School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Sarah E. Drew
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
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White V, Daly C, Anazodo A, Bibby H, Orme LM, Pinkerton R, Pole JD, Thompson K, Nathan PC, Baxter NN, Gupta S. The Australian-Canadian Adolescent and Young Adult Collaborative Cohort Initiative: Initial Meeting Report. J Adolesc Young Adult Oncol 2016; 6:1-5. [PMID: 27564221 DOI: 10.1089/jayao.2016.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victoria White
- 1 Centre for Behavioural Research in Cancer, Cancer Council Victoria , Melbourne, Australia
| | - Corinne Daly
- 2 Department of Surgery, Li Ki Shing Knowledge Institute , St. Michael's Hospital, Toronto, Ontario, Canada
| | - Antoinette Anazodo
- 3 Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia .,4 Nulune Comprehensive Cancer Centre, Bright Alliance, Prince of Wales Hospital , Randwick, New South Wales, Australia
| | - Helen Bibby
- 1 Centre for Behavioural Research in Cancer, Cancer Council Victoria , Melbourne, Australia
| | - Lisa M Orme
- 5 Children's Cancer Centre, Royal Children's Hospital , Melbourne, Victoria, Australia .,6 Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Ross Pinkerton
- 7 Children's Health Queensland Hospital and Health Service , Brisbane, Queensland, Australia
| | - Jason D Pole
- 8 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada .,9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada
| | - Kate Thompson
- 6 Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Paul C Nathan
- 9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .,10 Division of Haematology/Oncology, The Hospital for Sick Children , Toronto, Ontario, Canada .,11 Institute for Health Policy, Evaluation and Management, University of Toronto , Toronto, Ontario, Canada
| | - Nancy N Baxter
- 2 Department of Surgery, Li Ki Shing Knowledge Institute , St. Michael's Hospital, Toronto, Ontario, Canada .,9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .,11 Institute for Health Policy, Evaluation and Management, University of Toronto , Toronto, Ontario, Canada
| | - Sumit Gupta
- 9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .,10 Division of Haematology/Oncology, The Hospital for Sick Children , Toronto, Ontario, Canada .,11 Institute for Health Policy, Evaluation and Management, University of Toronto , Toronto, Ontario, Canada
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Barr RD. Planning a Comprehensive Program in Adolescent and Young Adult Oncology-A Collision with Reality. J Adolesc Young Adult Oncol 2016; 5:303-309. [PMID: 27159081 DOI: 10.1089/jayao.2016.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, McMaster University , Hamilton, Canada
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Hay AE, Rae C, Fraser GA, Meyer RM, Abbott LS, Bevan S, McBride ML, Cuvelier GDE, McKillop S, Barr RD. Accrual of adolescents and young adults with cancer to clinical trials. ACTA ACUST UNITED AC 2016; 23:e81-5. [PMID: 27122988 DOI: 10.3747/co.23.2925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cancer is the most common disease-related cause of death in 15- to 29-year-olds in Canada [...]
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Affiliation(s)
- A E Hay
- Canadian Cancer Trials Group and Department of Medicine, Queen's University, Kingston, ON
| | - C Rae
- McMaster University, Hamilton, ON
| | - G A Fraser
- Department of Oncology, McMaster University, and the Juravinski Hospital and Cancer Centre, Hamilton, ON
| | - R M Meyer
- Department of Oncology, McMaster University, and the Juravinski Hospital and Cancer Centre, Hamilton, ON
| | - L S Abbott
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON
| | - S Bevan
- Canadian Cancer Society, Toronto, ON
| | - M L McBride
- BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - G D E Cuvelier
- Department of Pediatrics and Child Health, University of Manitoba, and CancerCare Manitoba, Winnipeg, MB
| | - S McKillop
- Department of Pediatrics, Alberta Health Services, Calgary, AB
| | - R D Barr
- Department of Pediatrics, McMaster University, Hamilton, ON
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Shaw PH, Reed DR, Yeager N, Zebrack B, Castellino SM, Bleyer A. Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence. J Pediatr Hematol Oncol 2015; 37:161-9. [PMID: 25757020 DOI: 10.1097/mph.0000000000000318] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last 30 years, it has become apparent that oncology patients ages 15 to 39 have not reaped the same rewards of improved survival that we have seen in younger and older patients. As a result, in 2006 the Adolescent and Young Adult (AYA) Oncology Progress Review Group convened and examined the factors that impact the care of the 70,000 new cases per year (approximately 7% of all new cases) in the United States and published their findings. The reasons for inferior survival gains are of course multiple and include the settings in which patients are cared for, clinical trial enrollment, insurance coverage, varied treatment of sarcomas, varied treatment of acute lymphoblastic leukemia, the psychosocial impact of cancer and cancer survivorship. A new area of a yet-to-be completely defined subspecialty was born out of this meeting: AYA oncology. As a medical community we realized that these patients do not fit neatly into the pediatric nor adult world and, therefore, require a unique approach which many individuals, oncology centers, advocacy groups, and cooperative trial groups have started to address. This group of dedicated providers and advocates has made strides but there is still much work to be done on the local, national, and international level to make up for shortcomings in the medical system and improve outcomes. We review key components of AYA cancer care in 2015 that all providers should be aware of, how far we have come, where this movement is headed, and the obstacles that continue to stand in the way of better cure rates and quality of life after cure for this unique group of patients. Like an adolescent maturing into adulthood, this movement has learned from the past and is focused on moving into the future to achieve its goals.
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Affiliation(s)
- Peter H Shaw
- *Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA †Sarcoma Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL ‡Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH §University of Michigan School of Social Work, Ann Arbor, MI ∥Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC ¶Quality Department, St Charles Health System, Bend, OR
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Patterson P, McDonald FEJ, Zebrack B, Medlow S. Emerging issues among adolescent and young adult cancer survivors. Semin Oncol Nurs 2014; 31:53-9. [PMID: 25636395 DOI: 10.1016/j.soncn.2014.11.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To review the characteristics of cancer in the adolescence and young adult age group; the medical, psychosocial and behavioral late effects; survivorship care planning and transition; current research priorities; and practice implications. DATA SOURCE Published articles, research studies and position statements. CONCLUSION Survivors of cancers that occurred during adolescence and young adulthood (AYA) are confronted with the dual demands of managing their transition to independent adulthood, concurrently with their transition from cancer patient to cancer survivors, with an associated reduction in support from medical services. AYA survivors also face complex medical, psychosocial and behavioral late effects, including fertility and mental health issues. IMPLICATIONS FOR NURSING PRACTICE An understanding of the impact of cancer diagnoses among this age group, including survivors' abilities to reintegrate into 'normal' life and potential long term consequences, is necessary to provide the best support. This care and support can be enhanced through multidisciplinary teams who work together to address the medical and psychosocial needs of AYAs diagnosed with cancer.
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