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Reinman L, Schatz J, Johnston J, Bills S. Fatigue, Stress Appraisal, and Emotional Functioning Among Youth With Sickle Cell Disease: A Daily Diary Study. J Pediatr Psychol 2023; 48:562-571. [PMID: 37167536 PMCID: PMC10321392 DOI: 10.1093/jpepsy/jsad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess how fatigue is related to mood among youth with sickle cell disease (SCD) by evaluating if the cognitive appraisal of stress moderates the impact of fatigue on emotional functioning consistent with the Risk-and-Resistance Model of Chronic Illness. METHODS Daily diaries assessing fatigue (Numerical Rating Scale), pain intensity (Numerical Rating Scale), mood (Positive and Negative Affect Schedule for Children), and cognitive appraisal of stress (Stress Appraisal Measure for Adolescents) were collected from 25 youth with SCD (ages 11-18 years) for 8 consecutive weeks resulting in 644 daily diaries for analyses. RESULTS When measured concurrently, higher fatigue was associated with higher negative mood controlling for pain and prior-night sleep quality. Fatigue predicted next-day negative mood through its interaction with primary and secondary appraisal of stress, consistent with stress appraisal as a protective factor. A similar pattern was observed for pain, which, like fatigue, is a common SCD-related stressor. CONCLUSION Fatigue and negative mood are inter-related when concurrently assessed, but their temporal association in SCD suggests that mood changes are not an inevitable sequalae of increased fatigue; fatigue influenced subsequent levels of negative mood, but only in the presence of less adaptive cognitions about stress; specifically, a higher perceived threat from stress and a lower belief in the ability to manage stress. The results suggest specific cognitive targets for reducing the negative impact of fatigue on mood in SCD.
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Affiliation(s)
- Laura Reinman
- Department of Psychiatry, University of Colorado School of Medicine, USA
| | - Jeffrey Schatz
- Department of Psychology, University of South Carolina, USA
| | - Julia Johnston
- Department of Psychology, University of South Carolina, USA
| | - Sarah Bills
- Department of Psychology, University of South Carolina, USA
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Johnston JD, Reinman LC, Bills SE, Schatz JC. Sleep and fatigue among youth with sickle cell disease: A daily diary study. J Behav Med 2022:10.1007/s10865-022-00368-5. [PMID: 36334167 PMCID: PMC9638215 DOI: 10.1007/s10865-022-00368-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
Abstract
Youth with sickle cell disease (SCD) experience disease effects including vaso-occlusive pain crises, poor sleep quality, and fatigue. The present study examines how sleep quality and pain medications impact fatigue in youth with SCD. Daily diaries assessing pain, fatigue, sleep quality, mood, and use of pain medications from 25 youth with SCD ages 11 to 18 years were collected for eight consecutive weeks. Poor sleep quality predicted increases in next-day fatigue levels while controlling for pain and mood. Sleep quality did not moderate the existing temporal relationship between pain and next-day fatigue established by Reinman et al. (2019) as predicted. Non-opioid medications affected ratings of next-day fatigue but opioid medications did not. Sleep quality appears to play an important role in predicting next-day fatigue levels and may be an important target for intervention. Pain medication use did not substantially contribute to prospective fatigue levels among youth, but requires further study.
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Affiliation(s)
- Julia D Johnston
- Department of Psychology, University of South Carolina, 29208, Columbia, SC, USA.
| | - Laura C Reinman
- Department of Psychology, University of Colorado School of Medicine, 80045, Denver, CO, USA
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, 29208, Columbia, SC, USA
| | - Jeffrey C Schatz
- Department of Psychology, University of South Carolina, 29208, Columbia, SC, USA
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Steineck A, Bradford MC, O'Daffer A, Fladeboe KM, O'Donnell MB, Scott S, Yi-Frazier JP, Rosenberg AR. Quality of Life in Adolescents and Young Adults: The Role of Symptom Burden. J Pain Symptom Manage 2022; 64:244-253.e2. [PMID: 35649460 PMCID: PMC9378571 DOI: 10.1016/j.jpainsymman.2022.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Adolescents and young adults (AYAs) with cancer report worse health-related quality of life (HRQOL) than other age groups. Symptom burden is a modifiable predictor of HRQOL. OBJECTIVES The objective of this study was to identify which symptoms are most burdensome to AYAs with advanced cancer. METHODS In this observational study, English-speaking individuals aged 12-25 years undergoing treatment for advanced cancer completed assessments of symptom burden (Memorial Symptom Assessment Scale) and HRQOL (Pediatric Quality of Life Inventory Generic Form and Cancer Module; minimal clinically important difference 4.4). We dichotomized participants as having low (<7) or high (≥7) symptom prevalence. Mixed regression models estimated HRQOL differences between groups. For individual symptoms, unadjusted mixed models estimated HRQOL reductions. RESULTS N = 58 AYAs completed baseline surveys. The median age was 17 years (IQR 15-19), 58% were male, 59% identified as white, and 44% were diagnosed with leukemia/lymphoma. High symptom prevalence was associated with a mean generic HRQOL 7 points lower (95% CI: -11, -3; P < 0.01) and cancer-specific HRQOL score 12 points lower (95% CI: -17, -7; P < 0.01) than low symptom prevalence. The most prevalent symptoms were fatigue (71%), pain (58%), and difficulty sleeping (58%). Fatigue (-8), difficulty concentrating (-7), and mouth sores (-6) were associated with the greatest generic HRQOL score reductions. Dysphagia (-12), difficulty concentrating (-12), and sadness (-11) were associated with the greatest cancer-specific HRQOL score reductions. CONCLUSION The symptom experience among AYAs with advanced cancer is unique. Separate evaluation of AYA's symptoms may optimize management and improve HRQOL.
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Affiliation(s)
- Angela Steineck
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA; MACC Fund Center for Cancer and Blood Disorders (A.S.), Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Miranda C Bradford
- Core for Biostatistics (M.C.B.), Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Kaitlyn M Fladeboe
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Maeve B O'Donnell
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA
| | - Samantha Scott
- Department of Psychology (S.S.), University of Denver, Denver, Colorado, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA
| | - Abby R Rosenberg
- Seattle Children's Hospital (A.S.), Cancer and Blood Disorders Center, Seattle, Washington, USA; Seattle Children's Research Institute (A.S., A.O., K.M.F., M.B.O., J.P.Y-F., A.R.R.), Center for Clinical and Translational Research, Seattle, Washington, USA; University of Washington School of Medicine (A.S.), Department of Pediatrics, Seattle, Washington, USA; University of Washington (A.S., K.M.F., M.B.O., A.R.R.), Cambia Palliative Care Center of Excellence, Seattle, Washington, USA.
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4
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Im Y. Designing Appropriate Mixed Methods Nursing Research. J Korean Acad Nurs 2021; 51:133-137. [PMID: 33993120 DOI: 10.4040/jkan.51201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/09/2022]
Affiliation(s)
- YeoJin Im
- College of Nursing Science, Kyung Hee University, Seoul, Korea.
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5
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Ang SH, Koh SSL, Lee XHHT, Shorey S. Experiences of adolescents living with cancer: A descriptive qualitative study. J Child Health Care 2018; 22:532-544. [PMID: 29544352 DOI: 10.1177/1367493518763109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to explore the experiences of adolescents from Singapore, aged 10-18 years old, living with cancer and their perceptions on how their psychosocial outcomes can be improved. A descriptive qualitative study design was used. Convenience sampling was used to recruit 10 participants from a pediatric oncology ward in a Singapore hospital. Individual semi-structured interviews were conducted. Thematic analysis was used to analyze the data. Five major themes emerged: (1) experience of physical symptoms, (2) emotional response to their condition, (3) changes in social dynamics, and (4) falling behind in academics. The psychosocial outcomes of Singaporean adolescents with cancer could be improved by thorough pain assessments and creating a more conducive hospital environment.
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Affiliation(s)
- Sin Hui Ang
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Serena Siew Lin Koh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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6
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Ullrich CK, Dussel V, Orellana L, Kang TI, Rosenberg AR, Feudtner C, Wolfe J. Self-reported fatigue in children with advanced cancer: Results of the PediQUEST study. Cancer 2018; 124:3776-3783. [PMID: 30291811 DOI: 10.1002/cncr.31639] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/10/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric cancer-related fatigue is prevalent and significantly impairs health-related quality of life, yet its patterns and correlates are poorly understood. The objectives of this study were to describe fatigue as prospectively reported by children with advanced cancer and to identify the factors associated with fatigue and associated distress. METHODS Children (age ≥2 years) with advanced cancer (N = 104) or their parents at 3 academic hospitals reported symptoms at most weekly over 9 months using the computer-based Pediatric Quality of Life Evaluation of Symptoms Technology (PediQUEST) system. PediQUEST administered a modified version of the Memorial Symptom Assessment Scale (PQ-MSAS) as part of a randomized controlled trial. Clinical information was abstracted from medical records. Primary outcomes were: 1) fatigue prevalence (yes/no response to PQ-MSAS fatigue item) and 2) fatigue distress (composite score of severity, frequency, and bother). Multivariable models were constructed to identify factors independently associated with fatigue prevalence and scores reflecting fatigue distress (ie, burden). RESULTS Of 920 reports, 46% (n = 425) noted fatigue. When reported, fatigue was of high frequency in 41% of respondents (n = 174), severity in 25%of respondents (n = 107), and bother in 34%of respondents (n = 143). Most reports (84%; n = 358) were associated with scores indicating fatigue distress. In multivariable analyses, fatigue was associated with older age, lower hemoglobin, and distress from particular symptoms (anorexia, nausea, sleep disturbance, sadness, and irritability). In contrast, fatigue distress was associated with distress from nausea, cough, and pain. CONCLUSIONS Fatigue is common among children with advanced cancer and is often highly distressing. Interventions focused on uncontrolled symptoms may ease fatigue distress in children with advanced cancer.
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Affiliation(s)
- Christina K Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Veronica Dussel
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Center for Research and Implementation in Palliative Care, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Tammy I Kang
- Palliative Care Section, Texas Children's Hospital, Baylor School of Medicine, Houston, Texas
| | - Abby R Rosenberg
- Seattle Children's Hospital Cancer and Blood Disorders Center, Seattle, Washington.,Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Chien CH, Chang YY, Huang XY. The Lived Experiences of Adolescents With Cancer: A Phenomenological Study. Clin Nurs Res 2018; 29:217-225. [PMID: 30188183 DOI: 10.1177/1054773818799226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This descriptive phenomenological study was conducted to explore the lived experiences of adolescents with cancer. Purposive sampling was used to recruit participants. In-depth, nonstructured interviews were conducted to collect data, and narratives were analyzed using Colaizzi's seven-step method. Data saturation was achieved after interviewing 16 participants. The study was divided into three main themes and 16 subthemes: suffering (caused by symptoms, therapy, cancer recurrence, the feeling of being trapped in hospital, the burden of food therapy, delayed education, the absence of peer relationships, and limited activities), emotional reactions (fear, worry, sadness, anger, and loneliness), and rebalancing (strong family relationships, optimistic thinking, and healthy lifestyles). While adolescents with cancer experience changes in lifestyle, and physical, psychological, and social burden, they also have positive life experiences. Building appropriate learning systems, improving communication skill, and providing appropriate food therapy may alleviate the psychological burden experienced by young patients.
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Affiliation(s)
- Ching-Hui Chien
- National Taipei University of Nursing and Health Sciences, Taiwan
| | | | - Xuan-Yi Huang
- National Taipei University of Nursing and Health Sciences, Taiwan
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8
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Sodergren SC, Husson O, Rohde GE, Tomaszewska IM, Vivat B, Yarom N, Griffiths H, Darlington AS. A Life Put on Pause: An Exploration of the Health-Related Quality of Life Issues Relevant to Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2018; 7:453-464. [DOI: 10.1089/jayao.2017.0110] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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
| | - Gudrun E. Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, United Kingdom
| | - Iwona M. Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, United Kingdom
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helen Griffiths
- Department of Psychological Medicine, Oxford University Hospital, Oxford, United Kingdom
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9
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Tomlinson D, Robinson P, Oberoi S, Cataudella D, Culos-Reed N, Davis H, Duong N, Gibson F, Götte M, Hinds P, Nijhof S, van der Torre P, Cabral S, Dupuis L, Sung L. Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis. Curr Oncol 2018; 25:e152-e167. [PMID: 29719440 PMCID: PMC5927795 DOI: 10.3747/co.25.3883] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct). Methods For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, cinahl, and Psychinfo for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of hsct. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models. Results In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), l-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (smd): -0.52; 95% confidence interval (ci): -0.89 to -0.14] and with methylphenidate (smd: -0.36; 95% ci: -0.56 to -0.15); modafinil (or armodafinil) and corticosteroids were not effective. Conclusions Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of hsct. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.
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Affiliation(s)
- D. Tomlinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | | | - S. Oberoi
- Pediatric Oncology Group of Ontario, Toronto, ON
| | - D. Cataudella
- Department of Pediatric Psychology, Children’s Hospital, London Health Sciences Centre, London, ON
| | - N. Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB
| | - H. Davis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - N. Duong
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - F. Gibson
- Centre for Outcomes and Experiences Research in Children’s Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, and School of Health Sciences, University of Surrey, Guildford, U.K
| | - M. Götte
- University Hospital Essen, Center for Child and Adolescent Medicine, Department of Pediatric Hematology/Oncology, Essen, Germany
| | - P. Hinds
- Department of Nursing Science, Professional Practice, and Quality, Children’s National Health System; and Department of Pediatrics, George Washington University, Washington, DC, U.S.A
| | - S.L. Nijhof
- Division of Pediatrics, Wilhelmina Children’s Hospital (part of UMC Utrecht), Utrecht, Netherlands
| | - P. van der Torre
- Division of Pediatrics, Wilhelmina Children’s Hospital (part of UMC Utrecht), Utrecht, Netherlands
| | - S. Cabral
- Pediatric Oncology Group of Ontario, Toronto, ON
| | - L.L. Dupuis
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- Department of Pharmacy, The Hospital for Sick Children; and Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, ON
| | - L. Sung
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON
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Spathis A, Hatcher H, Booth S, Gibson F, Stone P, Abbas L, Barclay M, Brimicombe J, Thiemann P, McCabe MG, Campsey R, Hooker L, Moss W, Robson J, Barclay S. Cancer-Related Fatigue in Adolescents and Young Adults After Cancer Treatment: Persistent and Poorly Managed. J Adolesc Young Adult Oncol 2017; 6:489-493. [PMID: 28714766 PMCID: PMC5649403 DOI: 10.1089/jayao.2017.0037] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cancer-related fatigue is the most prevalent and distressing symptom experienced by adolescents and young adults (AYAs). An electronic survey was undertaken to ascertain current fatigue management and perceptions of its effectiveness. Eighty-five percent of responders (68/80) experienced fatigue, and it was worse more than 1 year after cancer treatment ended, compared to <1 year (p = 0.007). Forty-one percent received no fatigue management. Although advice to exercise was the most frequent intervention, the greatest impact of fatigue was on the ability to exercise and most did not find exercise advice helpful. Early intervention is warranted, supporting AYAs to persevere with increasing activity.
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Affiliation(s)
- Anna Spathis
- 1 Cambridge University Hospitals NHS Foundation Trust , Cambridge, United Kingdom .,2 University of Cambridge , Cambridge, United Kingdom
| | - Helen Hatcher
- 1 Cambridge University Hospitals NHS Foundation Trust , Cambridge, United Kingdom
| | - Sara Booth
- 2 University of Cambridge , Cambridge, United Kingdom
| | - Faith Gibson
- 3 Great Ormond Street Hospital for Children NHS Foundation Trust , London, United Kingdom .,4 University of Surrey , Guildford, United Kingdom
| | - Paddy Stone
- 5 University College , London, United Kingdom
| | - Laura Abbas
- 1 Cambridge University Hospitals NHS Foundation Trust , Cambridge, United Kingdom
| | - Matt Barclay
- 2 University of Cambridge , Cambridge, United Kingdom
| | | | - Pia Thiemann
- 2 University of Cambridge , Cambridge, United Kingdom
| | | | - Rachel Campsey
- 7 The Christie NHS Foundation Trust , Manchester, United Kingdom
| | - Louise Hooker
- 8 University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Wendy Moss
- 1 Cambridge University Hospitals NHS Foundation Trust , Cambridge, United Kingdom
| | - Jane Robson
- 1 Cambridge University Hospitals NHS Foundation Trust , Cambridge, United Kingdom
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11
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Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, Dyar R, Darlington AS. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017; 26:1659-1672. [PMID: 28251543 PMCID: PMC5486886 DOI: 10.1007/s11136-017-1520-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
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Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica Robinson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK
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12
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Spathis A, Booth S, Grove S, Hatcher H, Kuhn I, Barclay S. Teenage and Young Adult Cancer-Related Fatigue Is Prevalent, Distressing, and Neglected: It Is Time to Intervene. A Systematic Literature Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2016; 4:3-17. [PMID: 25852970 DOI: 10.1089/jayao.2014.0023] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Cancer-related fatigue in adults has been the subject of considerable recent research, confirming its importance as a common and debilitating symptom, and establishing a number of evidence-based interventions. There has, however, been limited focus on the fatigue suffered by teenagers and young adults with cancer, a group recognized as having unique experiences and developmental needs. We have undertaken a systematic review of the literature to provide a comprehensive overview of studies evaluating fatigue in this younger patient group in order to guide clinical practice and future research. METHOD We searched MEDLINE, EMBASE, PsycINFO, and CINAHL databases for literature containing data relating to any aspect of fatigue in patients aged 13-24 at cancer diagnosis or treatment. RESULTS Sixty articles were identified, of which five described interventional clinical trials. Cancer-related fatigue was consistently one of the most prevalent, severe, and distressing symptoms, and it persisted long-term in survivors. It was associated with a number of factors, including poor sleep, depression, and chemotherapy. There was little evidence for the effectiveness of any intervention, although exercise appears to be the most promising. Importantly, fatigue was itself a significant barrier to physical and social activities. CONCLUSION Cancer-related fatigue is a major and disabling problem in young cancer patients. Effective management strategies are needed to avoid compounding the dependence and social isolation of this vulnerable patient group. Future research should focus on providing evidence for the effectiveness of interventions, of which activity promotion and management of concurrent symptoms are the most promising.
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Affiliation(s)
- Anna Spathis
- Department of Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom . ; Department of Public Health and Primary Care, University of Cambridge , Cambridge, United Kingdom
| | - Sara Booth
- Department of Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom . ; University of Cambridge , Cambridge, United Kingdom
| | - Sarah Grove
- Department of Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom
| | - Helen Hatcher
- TYA Cancer Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust Foundation , Cambridge, United Kingdom
| | - Isla Kuhn
- University of Cambridge Medical Library , Cambridge, United Kingdom
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge , Cambridge, United Kingdom
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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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15
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Yılmaz HB, Gerçeker GÖ, Muslu GK. Evaluating the cancer related fatigue by children, mothers, and nurses in Turkish pediatric oncology patients. Eur J Oncol Nurs 2016; 23:66-71. [PMID: 27456377 DOI: 10.1016/j.ejon.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/25/2016] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to evaluate cancer related fatigue by children', mothers', and nurses' perspectives in recently diagnosed pediatric oncology patients, to evaluate levels of agreement between the fatigue scales, and to evaluate the relationships between fatigue and sample characteristics. METHOD The sample of this cohort, descriptive, correlational study consisted of 26 recently cancer diagnosed children between the ages of 7 and 12, receiving inpatient treatment in pediatric oncology/hematology units, their mothers and their nurses. The data about children's fatigue were collected using the Child Fatigue Scale-24 h, Parent Fatigue Scale-24 h and Staff Fatigue Scale-24 h, for two consecutive days in the second and third weeks of the patient's first chemotherapy treatment cycle. RESULTS The mean scores of the Child Fatigue Scale-24 h showed the children's fatigue to be at a moderate level, a statistically significant difference was found between the CFS-24 h and PFS-24 h mean scores in the first and second measurement (p < 0.05). The Intraclass correlation showed a good agreement between scales and repeated measurements for these scales. CONCLUSION Fatigue in recently diagnosed cancer patients is an important symptom which is of particular concern to the children, their parents and nurses. The study showed that these three scales can be used alone an also used simultaneously, and also proved that these scales are reliable for repeated measurements.
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Affiliation(s)
- Hatice Bal Yılmaz
- Ege University Faculty of Nursing, Pediatric Nursing Department, Bornova, Izmir, Turkey.
| | - Gülçin Özalp Gerçeker
- Ege University Faculty of Nursing, Pediatric Nursing Department, Bornova, Izmir, Turkey.
| | - Gonca Karayağız Muslu
- Muğla Sıtkı Koçman University, Fethiye Health School, Pediatric Nursing Department, Fethiye, Muğla, Turkey.
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Rodgers C, Sanborn C, Taylor O, Gundy P, Pasvogel A, Moore IMK, Hockenberry MJ. Fatigue and Oxidative Stress in Children Undergoing Leukemia Treatment. Biol Res Nurs 2016; 18:515-20. [PMID: 27179013 DOI: 10.1177/1099800416647794] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fatigue is a frequent and distressing symptom in children undergoing leukemia treatment; however, little is known about factors influencing this symptom. Antioxidants such as glutathione can decrease symptom severity in adult oncology patients, but no study has evaluated antioxidants' effects on symptoms in pediatric oncology patients. This study describes fatigue patterns and associations of fatigue with antioxidants represented by reduced glutathione (GSH) and the reduced/oxidized glutathione (GSH/GSSG) ratio among children receiving leukemia treatment. A repeated measures design assessed fatigue and antioxidants among 38 children from two large U.S. cancer centers. Fatigue was assessed among school-age children and by parent proxy among young children. Antioxidants (GSH and GSH/GSSG ratio) were assessed from cerebrospinal fluid at four phases during leukemia treatment. Young children had a steady decline of fatigue from the end of induction treatment through the continuation phase of treatment, but no significant changes were noted among the school-age children. Mean antioxidant scores varied slightly over time; however, the GSH/GSSG ratios in these children were significantly lower than the normal ratio. Mean GSH/GSSG ratios significantly correlated to fatigue scores of the school-age children during early phases of treatment. Children with low mean GSH/GSSG ratios demonstrated oxidative stress. The low ratios noted early in therapy were significantly correlated with higher fatigue scores during induction and postinduction treatment phases. This finding suggests that increased oxidative stress during the more intensive phases of therapy may explain the experience of fatigue children report.
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Affiliation(s)
| | - Chelse Sanborn
- Duke Children's Hospital & Health Center, Durham, NC, USA
| | | | - Patricia Gundy
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Alice Pasvogel
- University of Arizona College of Nursing, Tucson, AZ, USA
| | - Ida M Ki Moore
- University of Arizona College of Nursing, Tucson, AZ, USA
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Tomlinson D, Zupanec S, Jones H, O’Sullivan C, Hesser T, Sung L. The lived experience of fatigue in children and adolescents with cancer: a systematic review. Support Care Cancer 2016; 24:3623-31. [DOI: 10.1007/s00520-016-3253-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/26/2016] [Indexed: 12/27/2022]
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Carroll S, Chalder T, Hemingway C, Heyman I, Moss-Morris R. Understanding fatigue in paediatric multiple sclerosis: a systematic review of clinical and psychosocial factors. Dev Med Child Neurol 2016; 58:229-39. [PMID: 26566789 DOI: 10.1111/dmcn.12964] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 01/25/2023]
Abstract
AIM Fatigue in children and adolescents with multiple sclerosis (caMS) is currently poorly understood. This review aimed to provide greater insight into this area and direction for future research by evaluating evidence of associations between fatigue and clinical, psychological, and social factors in caMS. METHOD Studies were identified by searching online databases, hand-searching reference lists, and requesting unpublished literature from key authors. Studies that examined fatigue in relation to at least one clinical, psychological, or social factor in caMS were included. Data on design, sample characteristics, measures of fatigue, clinical, psychological, and social variables, and key findings were extracted. Twelve studies were narratively synthesized. RESULTS Clinical factors appeared largely unrelated to fatigue, whereas associations between fatigue and tests of neurocognitive functioning, and fatigue and diagnosable psychiatric disorders, were mixed. However, fatigue and depressed mood consistently correlated. A small number of studies indicated associations between fatigue and reduced quality of life and school performance. INTERPRETATION A sufficient explanatory model of fatigue in caMS is lacking as studies in this area are few and diverse. Future research should endeavour to identify potentially modifiable clinical and psychosocial factors that are associated with fatigue in caMS so that interventions targeting such factors may be developed.
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Affiliation(s)
- Susan Carroll
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Isobel Heyman
- Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Linder LA, Ameringer S, Baggott C, Erickson J, Macpherson CF, Rodgers C, Stegenga K. Measures and Methods for Symptom and Symptom Cluster Assessment in Adolescents and Young Adults with Cancer. Semin Oncol Nurs 2015. [PMID: 26210199 DOI: 10.1016/j.soncn.2015.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To provide an overview of resources for measuring symptoms and symptom clusters in adolescents and young adults (AYAs) with cancer and to examine methodological strategies for evaluating symptom clusters. DATA SOURCES Published research articles and clinical experience. CONCLUSION Limited research has addressed symptoms and symptom clusters in AYAs with cancer. Reliable, valid, and developmentally appropriate measures are needed to advance this area of research. IMPLICATIONS FOR NURSING PRACTICE Use of mobile technology and mixed qualitative and quantitative methods to understand AYAs' experience of symptoms and symptom clusters could enhance symptom awareness and the evidence base for practice.
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Dreyer J, Schwartz-Attias I. Nursing care for adolescents and young adults with cancer: literature review. Acta Haematol 2014; 132:363-74. [PMID: 25228562 DOI: 10.1159/000360213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cancer patients belonging to the adolescent and young adult (AYA) age group have unique and very specific needs, which require special attention from the caring staff. The difficulty in maintaining the personal and professional development at this age is both natural and normal. Adding to this, coping with a life-threatening disease turns this stage in life into a period with many dilemmas and challenges of quite a complex nature. AYA patients have to deal with issues above and beyond the disease itself, which create a very complex coping picture. On top of that, prognosis for this age group has not improved in recent years, unlike the situation in other age groups like children and adults. The literature on this subject is extensive and comprehensive. However, most of the papers on this subject are very specific and narrow in their approach, each dealing with a specific topic. In this article, we bring together many different papers which make a wide and comprehensive picture of the subject of AYAs coping with cancer, coupled with recommendations for the caring staff. In this review we focus on the various aspects of the disease and treatments in AYAs, based on the conceptual model of quality of life proposed by Ferrell and colleagues [Cancer Nurs 1992;15:153-160; Cancer Nurs 1992;15:247-253], including physical, social, emotional and spiritual aspects. From the psychological standpoint, most of the papers discuss the negative aspects; however, in this article we try to include some articles from the positive psychology school of thought. From our findings it is apparent that there is an opportunity and need to further explore research in this regard. It is apparent that taking a unique approach to AYA cancer patients is needed in order to deal with the unique needs of this age group. This article aims at putting a framework around this issue, with actionable recommendations for the caring staff.
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Affiliation(s)
- Juliet Dreyer
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
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Olson K. Sleep-related disturbances among adolescents with cancer: a systematic review. Sleep Med 2014; 15:496-501. [DOI: 10.1016/j.sleep.2014.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
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Manookian A, Nasrabadi AN, Asadi M. Children's lived experiences of hematopoietic stem cell transplantation. Nurs Health Sci 2014; 16:314-20. [PMID: 24423256 DOI: 10.1111/nhs.12103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022]
Abstract
Although hematopoietic stem cell transplantation is a valuable treatment in many life-threatening pediatric disorders, a large number of children who receive hematopoietic stem cell transplantation are faced with a variety of physical and psychological problems throughout this process. In this study, we explored the lived experiences of these children during their treatment to provide a better understanding of their main concerns, emotions, and expectations. The participants were six children, aged between 6 and 17 years, who underwent hematopoietic stem cell transplantation. Data were collected through individual, in-depth, and semistructured interviews. Using interpretive phenomenological analysis, the findings revealed that the children experienced "transplantation rejoicing" in this "difficult passage", which was associated with "deepening of family ties". Awareness of these experiences, feelings, and concerns can help in the development of more professional interventions to provide children with holistic care during their hospitalization.
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Affiliation(s)
- Arpi Manookian
- School of Nursing and Midwifery, International Campus, Tehran University of Medical Sciences, Tehran, Iran
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Lewis P, Jordens CFC, Mooney-Somers J, Smith K, Kerridge I. Growing Up With Cancer. J Pediatr Oncol Nurs 2013; 30:311-9. [DOI: 10.1177/1043454213513839] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adolescence and young adulthood are transitional periods of rapid and dramatic personal change. Few events can cause as unpredictable and challenging alterations to this process as the onset of a serious illness, such as cancer. Although we know much about the physical and psychological consequences of having cancer at this time, we know little about the effect of cancer on young people’s relationships. We conducted interviews with 15 women and 12 men aged between 16 and 29 years, who had survived cancer. Our findings demonstrate that the experience of cancer and how it affects relationships is complex. It arrests young people’s development by increasing their dependence on parents, giving them life experiences unavailable to peers, and complicating the process of establishing new relationships. However, it also accelerates development by facilitating closer and more mature relationships with parents and giving young people wisdom and insight not shared by peers. Cancer profoundly shapes how young people conduct their relationships. These changes require ongoing accommodation by young people with cancer, their parents, peers, and new acquaintances.
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Affiliation(s)
- Peter Lewis
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | - Kris Smith
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Ian Kerridge
- University of Sydney, Camperdown, New South Wales, Australia
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Daniel LC, Brumley LD, Schwartz LA. Fatigue in adolescents with cancer compared to healthy adolescents. Pediatr Blood Cancer 2013; 60:1902-7. [PMID: 23897651 PMCID: PMC4420143 DOI: 10.1002/pbc.24706] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 07/01/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer-related fatigue is one of the most pervasive and debilitating side-effects of cancer treatment and adolescents consistently rate cancer-related fatigue as one of the most distressing aspects of treatment. Because fatigue is also high in adolescents without cancer, the current study aims to describe fatigue in adolescents with cancer relative to a control group and to identify associates of such fatigue. Knowing this is important for understanding the extent of the problem in adolescents with cancer relative to healthy adolescents and for understanding who is most at risk for fatigue and related distress. PROCEDURE Adolescents with cancer and their caregivers (n = 102) and adolescents without a history of chronic health conditions and their caregivers (n = 97) completed the Multidimensional Fatigue Scale and measures of depression, quality of life (QoL), affect, coping, and family functioning. RESULTS Adolescents with cancer and their caregivers reported significantly more adolescent fatigue across all domains (with the exception of adolescent reports of cognitive fatigue) relative to adolescents without chronic health conditions. Higher fatigue was significantly related to adolescent report of more symptoms of depression, poorer QoL, higher negative affect, less positive affect, and behavioral disengagement coping style. Fatigue was not related to active coping or family functioning. CONCLUSIONS Adolescents with cancer experience significantly more fatigue than peers without chronic health conditions. Reports of fatigue are closely related to multiple indicators of psychosocial well-being, suggesting that fatigue may be an important cancer-related symptom to assess and manage to improve adolescent QoL.
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Affiliation(s)
- Lauren C. Daniel
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Correspondence to: Lauren Daniel, The Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, CTRB 10-30011, Philadelphia PA 19104.
| | - Lauren D. Brumley
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa A. Schwartz
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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Tham SW, Holley AL, Zhou C, Clarke GN, Palermo TM. Longitudinal course and risk factors for fatigue in adolescents: the mediating role of sleep disturbances. J Pediatr Psychol 2013; 38:1070-80. [PMID: 23860262 DOI: 10.1093/jpepsy/jst051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study (1) examines fatigue over 1 year in adolescents with chronic pain (n = 61) and depressive disorders (n = 51) compared with healthy adolescents (n = 60), (2) identifies longitudinal risk factors, and (3) tests sleep disturbances as a mediator between depression and fatigue. METHODS Adolescents completed questionnaires at baseline, 6, and 12 months. Mixed effects models examined associations between risk factors and fatigue; structural equation modeling assessed contemporaneous and longitudinal mediation. RESULTS Results revealed fatigue persisted at 1 year follow-up, with adolescents in the clinical samples experiencing greater fatigue than healthy youth at all time points (ps < .001). Age, baseline depression, and baseline sleep disturbances predicted longitudinal fatigue for the total sample (ps < .05), with variation in predictors by subgroup. Sleep quality mediated the contemporaneous effects of depression on fatigue in the clinical samples (ps < .05). CONCLUSIONS Findings underscore the longitudinal course of fatigue and suggest that improving sleep disturbances may reduce fatigue in clinical samples.
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Affiliation(s)
- See Wan Tham
- M.B.B.S, Senior Fellow & Acting Instructor, Dept. of Anesthesiology & Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105, USA.
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Erickson JM, MacPherson CF, Ameringer S, Baggott C, Linder L, Stegenga K. Symptoms and symptom clusters in adolescents receiving cancer treatment: A review of the literature. Int J Nurs Stud 2013. [DOI: 10.1016/j.ijnurstu.2012.10.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Developing a conceptual model of teenage and young adult experiences of cancer through meta-synthesis. Int J Nurs Stud 2012; 50:832-46. [PMID: 23044049 DOI: 10.1016/j.ijnurstu.2012.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 09/09/2012] [Accepted: 09/10/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To systematically identify and analyse published research exploring teenage and young adult experience of cancer to inform the development of a patient-reported outcome survey intended to explore if a correlation exists between specialist cancer care and quality of life for young people with cancer. DESIGN Systematic review and meta-synthesis. DATA SOURCES Medline, CINAHL Plus and PsycInfo were searched for literature published between 1987 and 2011. REVIEW METHODS Search terms included those for: population (e.g. teen, young adult); intervention (e.g. cancer); outcome (e.g. experience); and study type (e.g. qualitative). INCLUSION CRITERIA adolescents and young adults were both represented; diagnosis of cancer; published in English; and used qualitative methods to report an aspect of the cancer experience. Studies were excluded if they were reporting: palliative care experience; secondary data; or proxy views, i.e. parent or health professional perspective. Methodological quality was assessed using Cesario criteria and meta-synthesis involved deconstruction and decontextualising findings to identify common themes. RESULTS Three hundred and fifteen studies were identified, 17 fulfilled the inclusion criteria. Of these, most (59%), were assessed as being high quality, none were rated poor. Nine common themes were identified: psychosocial function, importance of peers, experience of healthcare, importance of support, impact of symptoms, striving for normality, impact of diagnosis, positive experiences, and financial consequences. CONCLUSIONS The conceptual model developed from the meta-synthesis depicts the mediators and consequences of cancer care that impact on young people's quality of life after a cancer diagnosis. The model highlights areas that require further exploration.
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Gerceker GO, Yilmaz HB. Reliability and Validity of Turkish Versions of the Child, Parent and Staff Cancer Fatigue Scales. Asian Pac J Cancer Prev 2012. [DOI: 10.7314/apjcp.2012.13.7.3135] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kestler SA, LoBiondo-Wood G. Review of symptom experiences in children and adolescents with cancer. Cancer Nurs 2012; 35:E31-49. [PMID: 21760492 DOI: 10.1097/ncc.0b013e3182207a2a] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inadequate symptom relief in children and adolescents with cancer leads to unnecessary suffering. This review assesses research on children and adolescents with cancer that had been published from 2002 to 2010. OBJECTIVES The review identifies the symptom experiences of children and adolescents undergoing treatment and describes the progress that has been made since Docherty's 2003 systematic review of nurse researcher published studies from 1990 to 2002, which identified gaps in research on the symptoms of pediatric oncology patients. METHOD A computerized search of medical and nursing literature produced 50 published studies and 2 dissertations that addressed the symptom experiences of children and adolescents receiving treatment for cancer. RESULTS Pain from cancer-related procedures and fatigue were the most frequently identified symptoms, followed closely by nausea and vomiting. More preschool-aged subjects and nonwhite subjects need to be assessed, distinctions between age groups and gender should be explored, and instrumentation for the prereading group must be developed. CONCLUSIONS Research on symptoms experienced by children and adolescents has gained momentum within the last 10 years, and some of the gaps identified by Docherty have been addressed. Multicenter trials would increase sample sizes and decrease enrollment time. IMPLICATIONS FOR PRACTICE By synthesizing research completed from 2002 to 2010 on symptoms of children who had cancer, new ideas can be generated and shared with clinical nursing staff to improve patient care. Gaps to further direct research are also identified.
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Affiliation(s)
- Susan A Kestler
- University of Texas Health Science Center Houston, School of Nursing, Houston, TX 77030, USA.
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Miller E, Jacob E, Hockenberry MJ. Nausea, Pain, Fatigue, and Multiple Symptoms in Hospitalized Children With Cancer. Oncol Nurs Forum 2011; 38:E382-93. [DOI: 10.1188/11.onf.e382-e393] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Scott JA, Lasch KE, Barsevick AM, Piault-Louis E. Patients' Experiences With Cancer-Related Fatigue: A Review and Synthesis of Qualitative Research. Oncol Nurs Forum 2011; 38:E191-203. [DOI: 10.1188/11.onf.e191-e203] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tomlinson D, Hinds PS, Bartels U, Hendershot E, Sung L. Parent reports of quality of life for pediatric patients with cancer with no realistic chance of cure. J Clin Oncol 2011; 29:639-45. [PMID: 21245433 DOI: 10.1200/jco.2010.31.4047] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare quality of life of children with cancer with no reasonable chance of cure reported by parents 6 months or fewer versus more than 6 months before death. PATIENTS AND METHODS This cross-sectional study included children between the ages of 2 and 18 years with cancer and no reasonable chance of cure at The Hospital for Sick Children, Toronto, Ontario, Canada. Parents reported quality of life on behalf of their children. Outcomes were the PedsQL 4.0 Generic Core Scales, Acute Cancer Module, and Multidimensional Fatigue Scale. RESULTS Seventy-three parents of children participated. Compared with children who survived more than 6 months (n = 43), those who died at 6 months or fewer (n = 30) had significantly worse physical health (mean difference, 15.9; 95% CI, 1.8 to 30.0; P = .028), more pain and hurt (mean difference, 15.5; 95% CI, 0.9 to 30.0; P = .037), and worse general fatigue (mean difference, 15.8; 95% CI, 2.4 to 29.1; P = .021) and sleep/rest fatigue (mean difference, 16.0; 95% CI, 3.5 to 28.5; P = .013). Among the entire cohort, those with leukemia/lymphoma had worse physical and psychosocial quality of life compared with those with solid or brain tumors. Recent stem-cell transplantation was associated with worse psychosocial health. CONCLUSION Parents of children with cancer reported worse physical health, pain, and fatigue proximal to death. Those with leukemia/lymphoma were at higher risk for impaired quality of life. This knowledge can help in the design of targeted interventions to improve quality of life for children dying as a result of cancer.
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Affiliation(s)
- Deborah Tomlinson
- Division of Haematology/Oncology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada
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Erickson JM, Beck SL, Christian B, Dudley WN, Hollen PJ, Albritton K, Sennett MM, Dillon R, Godder K. Patterns of fatigue in adolescents receiving chemotherapy. Oncol Nurs Forum 2010; 37:444-55. [PMID: 20591804 DOI: 10.1188/10.onf.444-455] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe patterns of fatigue in adolescents and the impact of fatigue during one month of chemotherapy, to explore variables that affect fatigue, and to explore the feasibility of collecting daily self-report data in this population. DESIGN Longitudinal, descriptive. SETTING Two pediatric oncology centers in central Virginia. SAMPLE 20 adolescents with a variety of cancer diagnoses receiving chemotherapy. METHODS Adolescents described daily fatigue for one month using rating scales and qualitative diaries. MAIN RESEARCH VARIABLES Fatigue severity. FINDINGS Adolescents commonly reported a peak in fatigue in the days immediately following chemotherapy administration. The most common pattern for adolescents who received chemotherapy on a schedule every three to four weeks was a "declining rollercoaster" pattern, with fatigue severity alternating on a daily basis but gradually declining until chemotherapy was scheduled again. Adolescents who received chemotherapy weekly showed more frequent peaks and troughs (the "yo-yo" pattern) that did not diminish in severity over the weeks of the study. Adolescents associated fatigue with other symptoms, particularly sleep-wake disturbances, pain, and nausea, and frequently reported that fatigue interfered with daily activities. CONCLUSIONS Fatigue commonly bothers adolescents receiving chemotherapy, particularly in the days following chemotherapy administration and when other symptoms are present. Although fatigue interfered with the adolescents' abilities to maintain their usual lifestyles, many still participated in the typical activities of adolescence. IMPLICATIONS FOR NURSING Fatigue is a complex and dynamic symptom. Oncology clinicians and researchers should frequently assess fatigue in adolescents receiving chemotherapy and apply timely and tailored interventions to match the factors that contribute to fatigue and influence fatigue severity. Management of fatigue during treatment will help adolescents stay involved in age-related activities and meet developmental milestones.
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Taylor RM, Franck LS, Dhawan A, Gibson F. The stories of young people living with a liver transplant. QUALITATIVE HEALTH RESEARCH 2010; 20:1076-1090. [PMID: 20442344 DOI: 10.1177/1049732310368405] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Adolescence is a difficult time for those with chronic illness because of the constraints of the illness on developmental tasks. Little is known about the impact liver transplantation has during adolescence. In this study we aimed to explore, in their own words, young people's lived experience of life after transplantation. We used semistructured interviews to collect narrative data, and used a purposive sample of 14 young people in early, middle, and late adolescence, transplanted for a range of chronic, acute, and metabolic liver diseases. We analyzed the transcripts using a framework in which analysis progresses through a five-stage process of matrices. Six main themes emerged, related to relationships, affect on schooling, tiredness and fatigue, acceptance of the burden of medication, communication with health professionals, and view of the future. These findings add new insight into the transplantation experience, which might lead to improvements in care and help direct further research in this important aspect of clinical care.
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Affiliation(s)
- Rachel M Taylor
- Department of Children's Nursing, Faculty of Health & Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
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Zupanec S, Jones H, Stremler R. Sleep Habits and Fatigue of Children Receiving Maintenance Chemotherapy for ALL and Their Parents. J Pediatr Oncol Nurs 2010; 27:217-28. [DOI: 10.1177/1043454209358890] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study of potential contributors to fatigue, such as sleep disturbance, has been identified as a research priority in pediatric cancer. The primary objective of this descriptive study was to explore relationships between sleep habits, sleep disturbance, and fatigue for children receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). This study also described sleep habits, sleep disturbance, and fatigue of parents of children and adolescents with ALL and determined if relationships existed between parent and child sleep disturbance and fatigue. Using a descriptive, cross-sectional design, children aged 4-18 years receiving maintenance chemotherapy for ALL and their parents completed questionnaires about their sleep and fatigue. Sleep disturbance was common in both children (87%) and parents (48%) and sleep disturbance scores were positively correlated with fatigue scores. From qualitative written responses to open-ended questions, 9 themes emerged related to sleep for children undergoing maintenance chemotherapy for ALL. Sleep differences noted since diagnosis included (1) sleep is disturbed, (2) sleep habits have changed, and (3) sleep is unchanged or improved. Things that got in the way of children sleeping well included (4) side effects of medication, especially dexamethasone; and (5) medication schedules. Things that helped children get sleep at night were (6) sleeping with someone, (7) comforting activities or routine, (8) medications, and (9) food and drink. Sleep disturbance in children on ALL maintenance and their parents is common and likely contributes to increased fatigue and is a potential target for nursing interventions.
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Affiliation(s)
- Sue Zupanec
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada,
| | - Heather Jones
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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CHIANG YC, YEH CH, WANG KW, YANG CP. The experience of cancer-related fatigue in Taiwanese children. Eur J Cancer Care (Engl) 2009; 18:43-9. [DOI: 10.1111/j.1365-2354.2007.00884.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Berg C, Neufeld P, Harvey J, Downes A, Hayashi RJ. Late Effects of Childhood Cancer, Participation, and Quality of Life of Adolescents. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2008. [DOI: 10.3928/15394492-20090611-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated the late effects of childhood cancer on participation and quality of life. Ninety-two percent of survivors (9 to 18 years of age) reported living with late effects of lower extremity pain and numbness, memory and attention deficits, and fatigue, depression, or both. Semistructured interviews with 25 survivors using the Canadian Occupational Performance Measure and the Adolescent Activity Card Sort captured frequencies, interests, and barriers for a range of activities. Survivors reported diminished engagement in vigorous leisure activities, chores, and community activities. Lower engagement in social activities was correlated with lower quality of life scores, as measured by the Pediatric Cancer Quality of Life Inventory-32. Despite these findings of significant cognitive and physical problems, none of the 25 survivors had individualized education programs in school, nor were any receiving occupational therapy at the time the survey was completed. The findings emphasize the importance of advocacy for occupational therapy services for survivors of childhood cancer and examination of adolescent survivor participation in, and goals for, typical activities.
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Linder LA. Developmental diversity in symptom research involving children and adolescents with cancer. J Pediatr Nurs 2008; 23:296-309. [PMID: 18638673 DOI: 10.1016/j.pedn.2007.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 10/03/2007] [Accepted: 10/08/2007] [Indexed: 11/25/2022]
Abstract
The purpose of this literature review was to evaluate developmental diversity in studies describing physical symptoms in children and adolescents receiving cancer treatment. Developmental diversity was conceptualized as individual differences based on normal stages of human development, including cognitive, psychosocial, and physiologic aspects. Searches of Medline and the Cumulative Index of Nursing and Allied Health Literature identified 53 articles published between January 1986 and November 2006. Most studies addressed symptoms in school-aged children and adolescents; few compared symptoms across age groups. Additional measures are needed to describe younger children's symptoms. Alternate research methodologies may be appropriate to describe their symptom experiences.
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Affiliation(s)
- Lauri A Linder
- University of Utah College of Nursing, Salt Lake City, UT 84112, USA.
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Yeh CH, Chiang YC, Lin L, Yang CP, Chien LC, Weaver MA, Chuang HL. Clinical factors associated with fatigue over time in paediatric oncology patients receiving chemotherapy. Br J Cancer 2008; 99:23-9. [PMID: 18577992 PMCID: PMC2453020 DOI: 10.1038/sj.bjc.6604434] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to investigate the relationships between clinical factors (including haemoglobin value, chemotherapeutic agents, and corticosteroid use) and changing patterns of fatigue before and for the next 10 days following the start of a new round of chemotherapy in children with cancer. A prospective longitudinal design was used to collect data from 48 paediatric oncology patients who were about to begin a new round of chemotherapy and their parents. Fatigue levels were assessed using multidomain questionnaires with three categories of patient self-report (including 'General Fatigue', 'Sleep/Rest Fatigue', and 'Cognitive Fatigue') and four categories of parent proxy-report (including 'Lack of Energy', 'Unable to Function', 'Altered Sleep', and 'Altered Mood'). The findings suggest that fatigue from both patient self-report and parent proxy-report changed significantly over time. The major findings from this study are that patients have more problems with fatigue in the first few days after the start of a cycle of chemotherapy. Corticosteroid use and haemoglobin value were associated with significant increases in fatigue that were sustained for several days and reached the highest level of fatigue at day 5 for those receiving concurrent steroids. The association of chemotherapeutic agents with fatigue varied between patient self-report and parent report, but the type of chemotherapeutic agents used was not associated with most changes in fatigue.
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Affiliation(s)
- C-H Yeh
- Graduate Institute of Nursing Science, Chang Gung University, Kwei-San, Tao-Yuen, Taiwan.
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Chiang YC, Hinds PS, Yeh CH, Yang CP. Development and psychometric testing of a Chinese version of the Fatigue Scale-Children in Taiwan. J Clin Nurs 2008; 17:1201-10. [DOI: 10.1111/j.1365-2702.2007.02138.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pavic M, Sève P, Rousset H, Debourdeau P. [Management of cancer-related fatigue]. Presse Med 2008; 37:957-66. [PMID: 18329242 DOI: 10.1016/j.lpm.2007.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 09/12/2007] [Accepted: 09/26/2007] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cancer-related fatigue is very common but its management remains frustrating. We thus sought to review current knowledge in this field: epidemiologic data, pathophysiological mechanisms, assessment, and treatment. METHODS We queried the Medline database for all articles on this topic published between 1997 and 2007 and analyzed the articles published in English and French, as well as some of the essential earlier work. RESULTS Approximately 60 to 96% of patients treated for cancer report fatigue. The prevalence of fatigue that persists after the disease is considered to be in remission is substantial. Fatigue is a multidimensional problem with biological, psychological, social, and personal aspects. Physical causes must be systematically considered (comorbidities, anemia, and endocrine disorders), but most cases remain unresolved. Many may be attributed to deconditioning. There is not now any pharmacological therapy that treats this symptom effectively. Some psychostimulants are being tested, but the initial results of the studies are contradictory. Exercise is the intervention for which there is the most evidence of effectiveness. CONCLUSION Cancer-related fatigue is a very common symptom for which no specific cause can usually be identified. In this situation, rest may be more harmful than exercise.
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Affiliation(s)
- Michel Pavic
- Service de médecine interne - oncologie, Hôpital d'instruction des armées Desgenettes, F-69003 Lyon, France.
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Wilkins K, Woodgate R. Designing a Mixed Methods Study in Pediatric Oncology Nursing Research. J Pediatr Oncol Nurs 2008; 25:24-33. [DOI: 10.1177/1043454207311914] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Despite the appeal of discovering the different strengths of various research methods, mixed methods research remains elusive in pediatric oncology nursing research. If pediatric oncology nurses are to succeed in mixing quantitative and qualitative methods, they need practical guidelines for managing the complex data and analyses of mixed methods research. This article discusses mixed methods terminology, designs, and key design features. Specific areas addressed include the myths about mixed methods research, types of mixed method research designs, steps involved in developing a mixed method research study, and the benefits and challenges of using mixed methods designs in pediatric oncology research. Examples of recent research studies that have combined quantitative and qualitative research methods are provided. The term mixed methods research is used throughout this article to reflect the use of both quantitative and qualitative methods within one study rather than the use of these methods in separate studies concerning the same research problem.
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Hinds PS, Hockenberry M, Tong X, Rai SN, Gattuso JS, McCarthy K, Pui CH, Srivastava DK. Validity and reliability of a new instrument to measure cancer-related fatigue in adolescents. J Pain Symptom Manage 2007; 34:607-18. [PMID: 17629669 PMCID: PMC2813698 DOI: 10.1016/j.jpainsymman.2007.01.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 01/26/2007] [Accepted: 02/02/2007] [Indexed: 11/23/2022]
Abstract
Adolescents undergoing treatment for cancer rate fatigue as their most prevalent and intense cancer- and treatment-related effect. Parents and staff rate it similarly. Despite its reported prevalence, intensity, and distressing effects, cancer-related fatigue in adolescents is not routinely assessed during or after cancer treatment. We contend that the insufficient clinical attention is primarily due to the lack of a reliable and valid self-report instrument with which adolescent cancer-related fatigue can be measured. Our aim was to determine the reliability and construct validity of a new instrument and its ability to measure change in fatigue over time. Initial testing involved 64 adolescents undergoing curative treatment of cancer who completed the Fatigue Scale-Adolescent (FS-A) at two to four key points in treatment in one of four studies. Internal consistency estimates ranged from 0.67 to 0.95. Validity estimates involving the FS-A with the parent version ranged from 0.13 to 0.76; estimates involving the staff version and the Reynolds Depression Scale were 0.27 and 0.87, respectively. Additional validity findings included significant fatigue differences between anemic and nonanemic patients (P=0.042) and the emergence of four factors in an exploratory factor analysis. Findings further indicate that the FS-A can be used to measure change over time (t=2.55, P<0.01). In summary, the FS-A has moderate to strong reliability and impressive validity coefficients for a new research instrument.
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Affiliation(s)
- Pamela S Hinds
- Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
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