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Cherven BO, Demedis J, Frederick NN. Sexual Health in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:717-724. [PMID: 37856773 DOI: 10.1200/jco.23.01390] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023] Open
Abstract
Sexual health (SH), an integral aspect of overall health and quality of life, can be negatively affected by cancer and cancer treatment. SH is influenced by biological, psychological, social, and cultural factors, and, for adolescents and young adults (AYAs), developmental factors. The AYA population (age 15-39 years) is diverse in terms of psychosexual development, interpersonal relationships, and varying levels of independence, resulting in unique SH needs for this population. AYAs with cancer are particularly vulnerable to unmet SH needs related to contraception and infection prevention, sexual function, body image, and romantic/sexual relationships. Sexual dysfunction during and after cancer treatment is reported by 30%-100% of AYA cancer survivors. Clinical guidelines recommend discussing SH and screening for dysfunction but currently lack specifics regarding psychosexual interventions and strategies for incorporating screening into clinical care. Research and clinical priorities include improved provider-AYA communication regarding SH, standardization of SH measures and screening tools, infrastructure to support the SH needs of AYAs across pediatric and adult clinical environments, and engagement of sexual and gender minority AYAs in research. As the field of SH in cancer evolves, interventions need to be tailored to the developmental needs that are unique to AYAs and address the multidimensional aspects of SH.
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Affiliation(s)
- Brooke O Cherven
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Jenna Demedis
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Natasha N Frederick
- Center for Cancer & Blood Disorders, Connecticut Children's, Hartford, CT
- Division of Hematology and Oncology, Department of Pediatrics, University of Connecticut School of Medicine, Mansfield, CT
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Hill TT, Cooper IR, Gill PK, Okonkwo-Dappa AJ, Heykoop CH. Learnings from Racialized Adolescents and Young Adults with Lived Experiences of Cancer: "It's Okay to Critique the System That Claims to Save Us". Curr Oncol 2024; 31:1091-1101. [PMID: 38392075 PMCID: PMC10888397 DOI: 10.3390/curroncol31020081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Interest in AYA cancer care has increased globally over the recent past; however, most of this work disproportionately represents white, heterosexual, middle-income, educated, and able-bodied people. There is recognition in the literature that cancer care systems are not structured nor designed to adequately serve people of colour or other equity-denied groups, and the structural racism in the system prevents prevention, treatment, and delivery of care. This work seeks to examine structural racism and the ways that it permeates into the lived experiences of AYAs in their cancer care. This article represents the first phase of an 18-month, patient-oriented, Participatory Action Research project focused on cancer care for racialized AYAs that is situated within a broader program of research focused on transforming cancer care for AYAs. Semi-structured interviews were completed with 18 AYAs who self-identify as racialized, have lived experiences with cancer, and have received treatment in Canada. Following participant review of their transcripts, the transcripts were de-identified, and then coded by three separate authors. Five main themes were identified using thematic analysis, including the need to feel supported through experiences with (in)fertility, be heard and not dismissed, advocate for self and have others advocate for you, be in community, and resist compliance.
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Affiliation(s)
- Tiffany T. Hill
- Anew Research Collaborative, Royal Roads University, Victoria, BC V9B 5Y2, Canada; (I.R.C.); (A.J.O.-D.); (C.H.H.)
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Husson O, Janssen SHM, Reeve BB, Sodergren SC, Cheung CK, McCabe MG, Salsman JM, van der Graaf WTA, Darlington AS. Protocol for the development of a Core Outcome Set (COS) for Adolescents and Young Adults (AYAs) with cancer. BMC Cancer 2024; 24:126. [PMID: 38267900 PMCID: PMC10809623 DOI: 10.1186/s12885-023-11716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer, defined as individuals aged 15-39 years at initial cancer diagnosis, form a unique population; they face age-specific issues as they transition to adulthood. This paper presents the protocol for the development of a core outcome set (COS) for AYAs with cancer. METHODS The methodological standards from the Core Outcome Measures in Effectiveness Trials (COMET) and the International Consortium for Health Outcomes Measurement (ICHOM) for COS development will guide the development of the COS for AYAs with cancer. The project will consist of the following phases: (1) define the scope of the COS; (2) establish the need for a COS in this field (3) assemble an international, multi-stakeholder working group; (4) develop a detailed protocol; (5) determine "what to measure" (i.e., outcomes); (6) determine "how to measure" (i.e., measures); and (7) determine "case-mix" variables. CONCLUSIONS The development of a COS for AYAs with cancer will facilitate the implementation of efficient and relevant standards for data collection, both for clinical trials and in routine healthcare, thereby increasing the usefulness of these data to improve the value of the care given to these underserved young cancer patients.
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Affiliation(s)
- Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Silvie H M Janssen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | | | | | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - John M Salsman
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, USA
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Tan CY, Francis-Levin N, Stelmak D, Iannarino NT, Zhang A, Herrel L, Ellman E, Walling E, Moravek MB, Chugh R, Zebrack B. Differentiating gender-based reproductive concerns among adolescent and young adult cancer patients: A mixed methods study. J Psychosoc Oncol 2024; 42:526-542. [PMID: 38164962 DOI: 10.1080/07347332.2023.2291798] [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: 01/03/2024]
Abstract
INTRODUCTION Few studies have examined the distinct reproductive concerns (RC) of men and women in the adolescent and young adult (AYA) cancer patient population. The purpose of this mixed-methods study was to explore and differentiate the RC of AYAs. METHODS Participants completed the Reproductive Concerns After Cancer (RCAC) scale and participated in a semistructured interview. Interviews were deductively coded based on an analytic schema derived from the RCAC. RESULTS After identifying participants through the electronic health record, 27 younger AYAs, ages 12-25, enrolled in the study. Four inductive themes emerged and differed by gender. These include differential temporality, acceptance, and openness to alternatives, partner influence, and parental/guardian influence. AYA men reported fewer RC (M = 49.4, SD = 9.6) compared to AYA women (M = 56.8, SD = 8.4). CONCLUSIONS Oncofertility care providers are advised to account for short- and long-ranging concerns based on AYAs' gender. Future evaluations of patient-reported outcome measures specific to AYA RC are recommended.
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Affiliation(s)
- Chiu Yi Tan
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nina Francis-Levin
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas T Iannarino
- Department of Language, Culture, and the Arts, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B Moravek
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Jackson Levin N, Tan CY, Stelmak D, Iannarino NT, Zhang A, Ellman E, Herrel LA, Walling EB, Moravek MB, Chugh R, Haymart MR, Zebrack B. Banking on Fertility Preservation: Financial Concern for Adolescent and Young Adult Cancer Patients Considering Oncofertility Services. J Adolesc Young Adult Oncol 2023; 12:710-717. [PMID: 36603107 PMCID: PMC10611956 DOI: 10.1089/jayao.2022.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Financial concern is a major issue for adolescent and young adult (AYA) cancer patients. Furthermore, unaddressed oncofertility challenges (e.g., infertility) are linked to psychological distress and decreased overall quality of life. Little is known about how financial concern in terms of oncofertility (i.e., concern regarding affording fertility preservation [FP] services) impacts AYAs' decision making and experiences. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred risk of infertility were recruited through electronic health record query. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to financial concern were identified. The Institutional Review Board at the University of Michigan approved this study (HUM#00157267). Results: Financial concern was a dominant theme across the qualitative data. Emergent themes included (1) varied access to health insurance, (2) presence of parental/guardian support, (3) reliance upon financial aid, (4) negotiating infertility risk, and (5) lack of preparation for long-term costs. AYAs relied heavily upon parents for out-of-pocket and insurance coverage support. Some participants sought financial aid when guided by providers. Several participants indicated that no financial support existed for their circumstance. Conclusions: Financial consequences in terms of oncofertility are a major issue affecting AYA cancer patients. The incidence and gravity of financial concern surrounding affording oncofertility services merits attention in future research (measuring financial resources of AYAs' parental/support networks), clinical practice (strategically addressing short- and long-term costs; tailored psychosocial support), and health care policy (promoting legislation to mandate pre- and post-treatment FP coverage).
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Affiliation(s)
- Nina Jackson Levin
- Department of Anthropology, School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas T. Iannarino
- Department of Language, Culture, and the Arts at University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A. Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily B. Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B. Moravek
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Internal Medicine, Endocrinology & Diabetes Clinic, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan R. Haymart
- Department of Metabolism, Endocrinology & Diabetes Clinic, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Ghazal LV, Watson SE, Gentry B, Santacroce SJ. "Both a life saver and totally shameful": young adult cancer survivors' perceptions of medical crowdfunding. J Cancer Surviv 2023; 17:332-341. [PMID: 35169983 PMCID: PMC9378759 DOI: 10.1007/s11764-022-01188-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Young adults (YAs) diagnosed with cancer face high financial burden at a time in their lives when they are financially vulnerable. Some turn to medical crowdfunding, that is, using social media and other means to raise funds or resources to offset medical and usual life expenses. Major research gaps exist regarding the experiences of those who pursued crowdfunding. Thus, the study purpose was to describe the perceptions of, and experiences with, medical crowdfunding among a sample of YA cancer survivors. METHODS In February 2021, we distributed an online survey to YAs with a history of a cancer diagnosis, who had received grants from an organization that offers financial assistance. We calculated descriptive statistics on the crowdfunding sample and employed thematic analysis to analyze the open-ended questions. RESULTS In this sample (N = 113), 46 YA cancer survivors had engaged in medical crowdfunding and shared their perceptions and experiences. Our central theme, "The Crowdfunding Compromise" captures the trade-offs participants faced, which included subthemes of "crowdfunding as useful/helpful," "factors associated with crowdfunding success," and "questioning the why?". CONCLUSIONS Among YA cancer survivors, medical crowdfunding brings shame and stigma in addition to financial support. YA cancer survivors demonstrate resilience in their attempts to find individual solutions to financial problems created by unchecked health care costs, the US health insurance infrastructure, and lack of legislation. IMPLICATIONS FOR CANCER SURVIVORS This study fills an important gap in understanding individual-level crowdfunding experiences. Implications include system-level approaches to addressing cancer-related financial burden and potential worsening of existing disparities through medical crowdfunding.
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Affiliation(s)
- Lauren V Ghazal
- Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan Ann, Arbor, MI, USA.
| | | | | | - Sheila J Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Levin NJ, Zhang A, Kattari S, Moravek M, Zebrack B. "Queer Insights": Considerations and Challenges for Assessing Sex, Gender Identity, and Sexual Orientation in Oncofertility Research. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2022; 3:111-128. [PMID: 38078047 PMCID: PMC10704859 DOI: 10.1891/lgbtq-2021-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This article addresses issues related to clinical and research approaches to oncofertility for adolescent and young adult (AYA) sexual and gender minority (SGM) cancer patients. Limited attention has been dedicated to understanding the extent to which oncofertility services are appropriately and equitably delivered to AYAs with diverse orientations toward sexual orientation, gender identity, and future family. Unresolved challenges to conducting research with this vulnerable population perpetuate a lack of adequate knowledge about SGM AYA oncofertility needs. Therefore, the purpose of this paper is to inform considerations of sex, gender identity, and sexual orientation for investigations that include SGM AYAs. In order to improve the knowledge base and clinical services for this population, we discuss (1) challenges to sampling this population; (2) categorization and survey logic (e.g., skip patterns) in light of fluid sexual orientation and gender identities; and (3) clinical implications of accurately assessing sex and gender for oncofertility research and practice. We also recommend strategies for producing inclusive and accurate assessments of sexual and gender identity categories in both research and clinical encounters with SGM AYAs. Incorporating "queer insights" into empirical research - that is, positioning queer theory at the center of oncofertility study design - is suggested as a future direction for oncofertility research and practice.
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Affiliation(s)
- Nina Jackson Levin
- University of Michigan, School of Social Work and Department of Anthropology
| | - Anao Zhang
- University of Michigan, School of Social Work
| | - Shanna Kattari
- University of Michigan, School of Social Work and Department of Women’s and Gender Studies
| | - Molly Moravek
- University of Michigan, Department of Obstetrics and Gynecology and Department of Urology, Ann Arbor, MI, USA
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Ghazal LV, Cole S, Salsman JM, Wagner L, Duan F, Gareen I, Lux L, Parsons SK, Cheung C, Loeb DM, Prasad P, Dinner S, Zebrack B. Social Genomics as a Framework for Understanding Health Disparities Among Adolescent and Young Adult Cancer Survivors: A Commentary. JCO Precis Oncol 2022; 6:e2100462. [PMID: 35772048 PMCID: PMC9259142 DOI: 10.1200/po.21.00462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lauren V Ghazal
- Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor, MI
| | - Steve Cole
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - John M Salsman
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC
| | - Lynne Wagner
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC
| | - Fenghai Duan
- Department of Biostatistics, Brown University, Providence, RI
| | - Ilana Gareen
- Department of Epidemiology and the Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Lauren Lux
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Cancer Center, Tufts Medical Center, Boston, MA
| | | | | | - Pinki Prasad
- Louisiana State University Health, New Orleans, LA
| | - Shira Dinner
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brad Zebrack
- Division of Cancer Control and Population Sciences, School of Social Work, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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Kastrinos AL, Bylund CL, Mullis MD, Wollney E, Sae-Hau M, Weiss E, Fisher CL. Parents Caring for Children Diagnosed with a Blood Cancer from Infancy to Emerging Adulthood: A Life span Perspective. J Adolesc Young Adult Oncol 2022; 11:61-67. [PMID: 34647791 PMCID: PMC9464088 DOI: 10.1089/jayao.2021.0070] [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: 02/03/2023] Open
Abstract
Purpose: Pediatric blood cancer diagnosis is a stressful experience for families as it can involve urgent treatment that can be life-threatening and require extended hospital stays. Little is known about the experiences of parent caregivers of children with a blood cancer during the diagnosis period and how families' needs may differ in light of the patient's developmental phase in the life span. Methods: We conducted semistructured in-depth interviews with 20 parent caregivers (aged 30-65) of children diagnosed with a blood cancer, recruited through The Leukemia & Lymphoma Society's (LLS) constituency. Interview transcripts were thematically analyzed using the constant comparative method. To elucidate similarities and differences in caregiving experiences, findings were compared across parents with children diagnosed in three developmental periods: infancy-early childhood, age 0-6 (n = 9); pre-early adolescence, aged 9-14 (n = 5); and late adolescence-emerging adulthood, aged 16-27 (n = 6). Results: Across all developmental periods, parents described three similar caregiving experiences during the diagnosis period: being persistent to obtain a diagnosis, attending to the child's quality of life challenges, and attending to their other children's well-being. Among caregivers of younger children, persistence was motivated by parental intuition and challenges included coping with traumatic physical and psychological impacts of treatment procedures. For caregivers of late adolescents-early adults, persistence was motivated by the child's self-assessment and fertility-related concerns emerged. Conclusion: Results illustrate core issues for parent blood cancer caregivers and highlight ways to tailor supportive resources that facilitate good communication practices and shared decision-making to children's distinct developmental needs.
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Affiliation(s)
- Amanda L. Kastrinos
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Address correspondence to: Amanda L. Kastrinos, PhD, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, USA
| | - Carma L. Bylund
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA.,College of Medicine, University of Florida, Gainesville, Florida, USA.,University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Michaela D. Mullis
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - Easton Wollney
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA.,University of Florida Health Cancer Center, Gainesville, Florida, USA
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Reinman L, Coons HL, Sopfe J, Casey R. Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors. CHILDREN 2021; 8:children8111058. [PMID: 34828771 PMCID: PMC8618923 DOI: 10.3390/children8111058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 01/23/2023]
Abstract
Adolescent and young adult (AYA) survivors of cancer have diverse psychosocial and medical needs, including those related to fertility and sexual health. Much of the focus of care around issues such as fertility and sexual health tends to be filtered through a biomedical lens. However, it is essential that health care providers assess and support AYA survivors using a biopsychosocial and contextual framework to ensure the most comprehensive and accurate understanding of AYA survivor needs, especially those related to psychosexual health. A trusting relationship between the multi-disciplinary medical team and the AYA survivor that allows for open discussion about the physical and psychosocial components of sexual health is key to providing best care and outcomes.
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Affiliation(s)
- Laura Reinman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- Correspondence:
| | - Helen L. Coons
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Jenna Sopfe
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (R.C.)
| | - Robert Casey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (R.C.)
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Lidington E, Vlooswijk C, Stallard K, Travis E, Younger E, Edwards P, Nandhabalan M, Hunter N, Sarpal N, Flett D, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Darlington AS, Gonzalez M, Sirohi B, van der Graaf WTA, Husson O. 'This is not part of my life plan': A qualitative study on the psychosocial experiences and practical challenges in young adults with cancer age 25 to 39 years at diagnosis. Eur J Cancer Care (Engl) 2021; 30:e13458. [PMID: 33942418 DOI: 10.1111/ecc.13458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Adolescents and young adults with cancer face unique psychosocial and practical issues. However, patients across this group encounter different life experiences, cancer diagnoses and treatment settings given the tailored services for patients ages 15 to 24. Here, we qualitatively explore the psychosocial experiences and practical challenges of young adults (YAs) with cancer diagnosed between ages 25 and 39 in the United Kingdom. METHODS We invited YAs diagnosed with cancer in the 5 years prior to enrolment at participating sites to take part in semi-structured interviews or focus groups. Transcripts were analysed using inductive thematic analysis. Two YA patients reviewed the results to ensure robustness. RESULTS Sixty-five YAs with varied diagnoses participated. Participants struggled to balance work, childcare and financial solvency with treatment. The halt in family and work life as well as changes in image and ability threatened participants' identity and perceived 'normality' as a YA, however, these also stimulated positive changes. YAs experienced social isolation from friends and family, including children. Many struggled to cope with uncertainty around treatment outcomes and disease recurrence. CONCLUSION The disruption of family and work life can lead to age-specific issues in YAs diagnosed with cancer. Age-tailored psychological and practical services must be considered.
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Affiliation(s)
| | - Carla Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | - Amy Din
- University of Southampton, Southampton, UK
| | - Naureen Starling
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - James Larkin
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | | | | | - Susana Banerjee
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Zoltan Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | | | - Bhawna Sirohi
- Barts Health NHS Trust, London, UK
- Apollo Proton Cancer Centre, Chennai, India
| | | | - Olga Husson
- Institute of Cancer Research, London, UK
- Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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12
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Cheung CK, Nishimoto PW, Katerere-Virima T, Helbling LE, Thomas BN, Tucker-Seeley R. Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework. J Psychosoc Oncol 2021; 40:473-490. [PMID: 34152263 DOI: 10.1080/07347332.2021.1937771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Examine whether an existing conceptual framework for understanding financial hardship following a cancer diagnosis captures experiences among military adolescent and young adult (AYA) patients. METHODOLOGICAL APPROACH Investigators conducted focus groups and key informant interviews (n = 24) with active-duty military AYA cancer patients, their spouses, cancer care providers, and commanders at a military medical center and military post. FINDINGS Content analysis and thematic abstraction revealed that military AYA cancer patients' experiences of financial hardship occur within material, psychosocial, and behavioral domains that are situated within the contextual influences of AYA development and military culture. Subsequently, investigators constructed an expanded conceptual framework for understanding the financial hardship of cancer to capture these contexts. CONCLUSION Differentiating experiences of financial hardship into material, psychosocial, and behavioral domains situated within life course development and occupational culture contexts, may inform development of interventions with aspects of financial hardship most impacted by cancer care.
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Affiliation(s)
| | | | | | - Laura E Helbling
- University of Maryland School of Social Work, Baltimore, MD, USA
| | | | - Reginald Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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13
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Lidington E, Darlington AS, Vlooswijk C, Beardsworth S, McCaffrey S, Tang S, Stallard K, Younger E, Edwards P, Ali AI, Nandhabalan M, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Gonzalez M, Sirohi B, Husson O, van der Graaf WTA. Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25-39 Years Old in the UK National Health Service. Clin Oncol (R Coll Radiol) 2021; 33:494-506. [PMID: 33722412 DOI: 10.1016/j.clon.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
AIMS Adolescents and young adults aged 15-39 years with cancer face unique medical, practical and psychosocial issues. In the UK, principal treatment centres and programmes have been designed to care for teenage and young adult patients aged 13-24 years in an age-appropriate manner. However, for young adults (YAs) aged 25-39 years with cancer, little access to age-specific support is available. The aim of this study was to examine this possible gap by qualitatively exploring YA care experiences, involving patients as research partners in the analysis to ensure robust results. MATERIALS AND METHODS We conducted a phenomenological qualitative study with YAs diagnosed with any cancer type between ages 25 and 39 years old in the last 5 years. Participants took part in interviews or focus groups and data were analysed using inductive thematic analysis. Results were shaped in an iterative process with the initial coders and four YA patients who did not participate in the study to improve the rigor of the results. RESULTS Sixty-five YAs with a range of tumour types participated. We identified seven themes and 13 subthemes. YAs found navigating the healthcare system difficult and commonly experienced prolonged diagnostic pathways. Participants felt under-informed about clinical details and the long-term implications of side-effects on daily life. YAs found online resources overwhelming but also a source of information and treatment support. Some patients regretted not discussing fertility before cancer treatment or felt uninformed or rushed when making fertility preservation decisions. A lack of age-tailored content or age-specific groups deterred YAs from accessing psychological support and rehabilitation services. CONCLUSIONS YAs with cancer may miss some benefits provided to teenagers and young adults in age-tailored cancer services. Improving services for YAs in adult settings should focus on provision of age-specific information and access to existing relevant support.
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Affiliation(s)
- E Lidington
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - C Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | | | | | - S Tang
- Imperial College Healthcare NHS Trust, London, UK; Public Health England, London, UK
| | | | - E Younger
- Royal Marsden NHS Foundation Trust, London, UK; Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Edwards
- Royal Marsden NHS Foundation Trust, London, UK
| | - A I Ali
- St George's University Hospital NHS Foundation Trust, London, UK
| | | | - A Din
- University of Southampton, Southampton, UK
| | - N Starling
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - S Stanway
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - S Banerjee
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - Z Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - M Gonzalez
- Imperial College Healthcare NHS Trust, London, UK
| | - B Sirohi
- Barts Health NHS Trust, London, UK; Apollo Proton Cancer Centre, Chennai, India
| | - O Husson
- Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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14
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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: 60] [Impact Index Per Article: 12.0] [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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15
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Levin NJ, Zebrack B, Cole SW. Psychosocial issues for adolescent and young adult cancer patients in a global context: A forward-looking approach. Pediatr Blood Cancer 2019; 66:e27789. [PMID: 31058418 PMCID: PMC10599653 DOI: 10.1002/pbc.27789] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 02/01/2023]
Abstract
The first decade of adolescent and young adult (AYA) oncology psychosocial care and research (2005-2015) was driven by a normative, developmental framework that assumed a generalizable life experience for AYAs that is distinct from both younger children and older adults. As we proceed through a second decade, new considerations emerge regarding diversity of life experiences as occurring within and influenced by a complex global context. The purpose of this paper is to review and provide commentary on the impact of global and contextual conditions on AYAs. We expound upon the effects of precarious labor conditions, changing timetables and priorities for developmental tasks, sexual and gender plurality, and expanding cultural diversity. We discuss the implications of social genomics and technology and social media for enhancing precision psychosocial medicine. To build a forward-looking approach, this paper calls for tailored, multilevel treatments that consider variability of AYAs within the social and global contexts in which they live.
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Affiliation(s)
- Nina Jackson Levin
- School of Social Work and Department of Anthropology, University of Michigan, Ann Arbor, Michigan
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Steve W. Cole
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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16
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Recio-Saucedo A, Gilbert A, Gerty S, Cutress R, Eccles D, Foster C. “It’s Like We Don’t Exist”: Tailoring Education for Young Women Undergoing Surgery for Early-Stage Breast Cancer. Oncol Nurs Forum 2018; 45:165-175. [DOI: 10.1188/18.onf.165-175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Husson O, Zebrack B, Block R, Embry L, Aguilar C, Hayes-Lattin B, Cole S. Personality Traits and Health-Related Quality of Life Among Adolescent and Young Adult Cancer Patients: The Role of Psychological Distress. J Adolesc Young Adult Oncol 2017; 6:358-362. [DOI: 10.1089/jayao.2016.0083] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bradley Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Leanne Embry
- Department of Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Christine Aguilar
- Department of Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Steve Cole
- HopeLab Foundation, Redwood City, California
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