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von Grundherr J, Elmers S, Koch B, Hail LA, Mann J, Escherich G, Bergelt C, Samland L, Jensen W, Vettorazzi E, Stark M, Valentini L, Baumann FT, Singer S, Reer R, Beller R, Calaminus G, Faber J, Classen CF, Gebauer J, Hilgendorf I, Koehler M, Puzik A, Salzmann N, Sander A, Schiffmann L, Sokalska-Duhme M, Schuster S, Kock-Schoppenhauer AK, Bokemeyer C, Sinn M, Stein A, Dwinger S, Salchow J. A Multimodal Lifestyle Psychosocial Survivorship Program in Young Cancer Survivors: The CARE for CAYA Program-A Randomized Clinical Trial Embedded in a Longitudinal Cohort Study. JAMA Netw Open 2024; 7:e242375. [PMID: 38526495 DOI: 10.1001/jamanetworkopen.2024.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Importance There is a lack of trials examining the effect of counseling interventions for child, adolescent, and younger adult (CAYA) cancer survivors. Objective To assess lifestyle habits and the psychosocial situation of CAYAs to determine the efficacy of needs-based interventions in the CARE for CAYA program (CFC-P). Design, Setting, and Participants The CFC-P was conducted as a multicenter program in 14 German outpatient clinics, mainly university cancer centers. Recruitment began January 1, 2018; a randomized clinical trial was conducted until July 15, 2019; and intervention was continued as a longitudinal cohort study until March 31, 2021. Data preparation was conducted from April 1, 2021, and analysis was conducted from August 14, 2021, to May 31, 2022. Herein, predefined confirmatory analyses pertain to the RCT and descriptive results relate to the overall longitudinal study. Data analysis was based on the full analysis set, which is as close as possible to the intention-to-treat principle. Intervention A comprehensive assessment determined needs in physical activity, nutrition and psychooncology. Those with high needs participated in 1 to 3 modules. In the RCT, the IG received 5 counseling sessions plus newsletters, while the control group CG received 1 counseling session. Main Outcomes and Measures The primary outcome was the change in the rate of CAYAs with high needs at 52 weeks. Secondary outcomes were feasibility, modular-specific end points, satisfaction, quality of life, and fatigue. Results Of 1502 approached CAYAs aged 15 to 39 years, 692 declined participation. Another 22 CAYAs were excluded, resulting in 788 participants. In the randomized clinical trial, 359 CAYAs were randomized (intervention group [IG], n = 183; control group [CG], n = 176), and 274 were followed up. In the RCT, the median age was 25.0 (IQR, 19.9-32.2) years; 226 were female (63.0%) and 133 male (37.0%). After 52 weeks, 120 CAYAs (87.0%) in the IG and 115 (86.5%) in the CG still had a high need in at least 1 module (odds ratio, 1.04; 95% CI, 0.51-2.11; P = .91). Both groups reported reduced needs, improved quality of life, reduced fatigue, and high satisfaction with the CFC-P. Conclusions and Relevance In this randomized clinical trial, the implementation of a lifestyle program in this cohort was deemed necessary, despite not meeting the primary outcome. The interventions did not alter the rate of high needs. The results may provide guidance for the development of multimodal interventions in the follow-up care of CAYAs. Trial Registration German Clinical Trial Register: DRKS00012504.
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Affiliation(s)
- Julia von Grundherr
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Elmers
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Koch
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lesley-Ann Hail
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Mann
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Pediatric Hematology and Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Bergelt
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Medical Psychology, Greifswald University Medicine, Greifswald, Germany
| | - Luisa Samland
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wiebke Jensen
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luzia Valentini
- Faculty of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany
| | - Freerk T Baumann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital of Cologne, Cologne, Germany
| | - Susanne Singer
- Institute for Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Services Research, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Rüdiger Reer
- Institute of Human Movement Science, Faculty of Psychology and Human Movement, University of Hamburg, Hamburg, Germany
| | - Ronja Beller
- Clinic for Pediatrics III, Department of Pediatric Hematology/Oncology, West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Venusberg Campus 1, Bonn, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Cancer Center, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Carl Friedrich Classen
- Pediatric Oncology and Palliative Care Section, University Medicine Rostock, Childrens' and Adolescents Hospital Rostock, Rostock, Germany
| | - Judith Gebauer
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, Jena, Deutschland
| | - Michael Koehler
- Department of Hematology and Oncology, University Hospital Magdeburg, Magdeburg, Germany
- Specialty Practice for Psycho-Oncology, Magdeburg, Germany
| | - Alexander Puzik
- Department of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Salzmann
- Pediatric Hematology and Oncology, University Children´s Hospital Muenster, Albert-Schweitzer Campus 1, Muenster, Germany
| | - Annette Sander
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Lisa Schiffmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-Universität Würzburg, CCC WERA, University Hospital Würzburg, Würzburg, Germany
| | - Magdalena Sokalska-Duhme
- Department of Pediatric Hematology, Oncology & Immunology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Sonja Schuster
- Pediatric Hematology and Oncology, Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Carsten Bokemeyer
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marianne Sinn
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Stein
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Dwinger
- Department for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jannike Salchow
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumor Center, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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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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Duan Y, Wang L, Sun Q, Liu X, Ding S, Cheng Q, Xie J, Cheng ASK. Prevalence and Determinants of Psychological Distress in Adolescent and Young Adult Patients with Cancer: A Multicenter Survey. Asia Pac J Oncol Nurs 2021; 8:314-321. [PMID: 33850965 PMCID: PMC8030586 DOI: 10.4103/2347-5625.311005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/25/2020] [Indexed: 01/01/2023] Open
Abstract
Objective This study aimed to investigate the current prevalence and determinants of psychological distress and the association of distress with general information, character strengths, medical coping, and social support in Chinese adolescents and young adults (AYAs) aged 15-39 years with cancer. Methods A multicenter survey was carried out. Eight hundred and nine patients completed the Chinese version of the National Comprehensive Cancer Network distress thermometer (DT), the three-dimensional inventory of character strengths, the medical coping modes questionnaire, and the Social Support Rating Scale. Results The current prevalence of psychological distress in Chinese AYAs with cancer was 83.4%. Binary logistic regression analysis showed that gender, age, educational level, marriage, monthly income, exercise intensity, cancer classifications, treatments, self-control, confrontation, avoidance, and subjective support were all associated with distress. AYA cancer patients who were female, younger, or divorced or had a lower monthly income, education level, or exercise intensity were more likely to have higher level of distress. Compared to AYAs with other cancer classifications, patients with digestive system malignancies, breast cancers, and head and neck malignancies had a higher prevalence of distress. Patients receiving chemotherapy or radiotherapy were more likely to be distressed. The higher the self-control, confrontation, avoidance, and subjective support scores were, the lower the prevalence of distress was among AYA cancer patients. Conclusions The prevalence of psychological distress in AYA cancer patients was relatively high. Potential interventions targeting exercise intensity, character strengths, medical coping, and social support may decrease the prevalence of psychological distress in this patient population.
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Affiliation(s)
- Yinglong Duan
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qian Sun
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Liu
- Health Management Centre, Hunan Cancer Hospital, Changsha, China
| | - Siqing Ding
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qinqin Cheng
- Pain Management Department, Hunan Cancer Hospital, Changsha, China
| | - Jianfei Xie
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Andy S K Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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