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Loecher N, Jordan A, Spunt SL, Simon P, Simons LE, Dahl G, Kosyluk K, Heathcote LC. "You don't accept he's completely ok": a reflexive thematic analysis of parents' roles in monitoring their child's health and symptoms after finishing childhood cancer treatment. J Cancer Surviv 2024; 18:950-959. [PMID: 36821041 DOI: 10.1007/s11764-023-01353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES/PURPOSE Childhood cancer survival brings continued mental and physical health challenges both for the child and for the family. In this study, we investigated how parents viewed their roles in their child's health and symptom monitoring during the survivorship period. METHODS Twenty-one parents of childhood cancer survivors (n = 18 mothers; parent mage = 49.78 years, child mage = 18.50 years; range = 12-25 years), whose children were at least one year off-treatment (m = 3.67 years; SD = 2.25; various diagnoses), completed semi-structured interviews. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. RESULTS Analyses generated three themes which reflect roles that parents may adopt in the context of monitoring symptoms in their childhood cancer survivor. "Vigilant Mama and Papa" (theme 1) described parents who expressed a strong sense of responsibility for protecting their child's health during survivorship resulting in careful monitoring of their child's symptoms and health. "Pragmatic Mamas and Papas" (theme 2) described parents who adopted an approach to symptom and health monitoring that emphasized moving past cancer and focusing on the future. Finally, "Encouraging Mamas and Papas" (theme 3) described parents who focused on educating and preparing their child to develop an autonomous approach to health and symptom self-monitoring as they transitioned to survivorship and adulthood. CONCLUSION Parents take on varying roles in monitoring their child's symptoms and health after finishing childhood cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS Understanding the ways in which parents continue to be involved in their child's cancer journey helps researchers develop interventions to support dyadic coping in survivorship.
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Affiliation(s)
- Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, 33613, USA.
| | - Abbie Jordan
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, UK
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela Simon
- Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary Dahl
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA
| | - Kristin Kosyluk
- Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL, 33613, USA
| | - Lauren C Heathcote
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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2
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Black LL, Peugh JL, Pai ALH. Health Competence Beliefs and Health-Related Quality of Life Among Adolescent and Young Adult Survivors of Childhood Cancer and Healthy Peers. J Adolesc Young Adult Oncol 2023; 12:653-661. [PMID: 36862533 DOI: 10.1089/jayao.2022.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors of childhood cancer are at risk for late-effects that can impact how one perceives their health and well-being. Understanding beliefs about health competence and well-being among survivors can help identify support needs and increase adherence to long-term follow-up guidelines. This study examined differences in health competence beliefs and health-related quality of life (HRQOL) between AYA survivors of childhood cancer and matched healthy peers. In addition, the relationship between health competence beliefs and HRQOL, as well as the moderating effect of cancer survivorship, was investigated. Methods: Survivors (n = 49) and healthy peers (n = 54) completed measures about health competence beliefs (i.e., Health Perception, Cognitive Competence, Autonomy, and School/Work Functioning) and HRQOL. Multiple group analysis was used to investigate differences in health competence beliefs and HRQOL between survivors and peers. Multivariate multiple regression analyses were used to investigate the relationships between health competence beliefs and HRQOL. Finally, a history of cancer was examined as a possible moderator using additional multivariate multiple regression analyses. Results: Survivors reported significantly lower Health Perception, Cognitive Competence, Autonomy, and School/Work Functioning scores compared to healthy peers. Among both groups, Health Perception and Cognitive Competence scores were associated with multiple domains of HRQOL. These relationships were not moderated by having a history of cancer. Conclusions: Perceptions about one's health and cognitive abilities may impact HRQOL among AYA survivors of childhood cancer and health peers. Identifying those at risk for poor well-being may help to guide interventions aimed at increasing adherence to medical recommendations.
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Affiliation(s)
- Lora L Black
- Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - James L Peugh
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical School, Cincinnati, Ohio, USA
| | - Ahna L H Pai
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical School, Cincinnati, Ohio, USA
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3
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Loecher N, Tran JT, Kosyluk K. Parental Perspectives on Health Care Transition in Adolescent and Young Adult Survivors of Pediatric Cancer. J Adolesc Young Adult Oncol 2023; 12:461-471. [PMID: 36459103 DOI: 10.1089/jayao.2022.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The health care transition (HCT) from pediatric to adult care is pivotal for childhood cancer survivors (CCS) and their parents. However, there is little research examining parental needs during HCT, despite this being a key predictor of successful HCT. The goal of this study was to investigate the needs of parents of CCS during HCT. Using an integrative review of the literature structured around the social-ecological model (SEM) of CCS transition readiness yielded 454 articles, including three hand-searched articles. Six articles were included in the final analysis. Data were extracted into nine factors derived from SEM. Articles were published within the last decade, largely qualitative, and mainly examined parents and CCS together. Parents most frequently mentioned relationships with their practitioner and CCS as contributing to HCT readiness, while abstract factors, such as goal-setting and expectations around HCT, were not mentioned. Our results are limited by the dearth of research on this topic, the homogeneity of samples, and joint presentation of CCS and parent data. Nonetheless, our results indicate that parents do not weigh all aspects of SEM equally, with macrolevel barriers, such as sociodemographic factors being viewed as less salient for HCT readiness. Parents mostly focused on interpersonal factors, such as their relationships with practitioners and CCS, indicating that practitioners should emphasize these in preparing parents for HCT.
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Affiliation(s)
- Nele Loecher
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
| | - Jennifer T Tran
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
| | - Kristin Kosyluk
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida, USA
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4
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Sadak KT, Gemeda M, Grafelman MC, Aremu TO, Neglia JP, Freyer DR, Harwood E, Mikal J. Identifying metrics of success for transitional care practices in childhood cancer survivorship: A qualitative interview study of parents. Cancer Med 2021; 10:6239-6248. [PMID: 34355520 PMCID: PMC8446395 DOI: 10.1002/cam4.4164] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Survivor‐focused care for adolescent and young adult (AYA) childhood cancer survivors (CCS) often involves their parents. Recognizing the importance of parents in the ongoing care of CCS, our study sought to identify key aspects of a successful transition for CCS from pediatric‐ to adult‐centered care from the parent perspective. Methods We conducted qualitative interviews with 26 parents of CCS who were receiving care in the long‐term follow‐up (LTFU) clinic at a single institution. We used a semi‐structured interview protocol with the parents and conducted a thematic content analysis. Results Using a constant comparison approach, data revealed three primary themes regarding parents’ perspectives toward ensuring a seamless transition from pediatric‐ to adult‐centered follow‐up care: (1) the transition needs to include seamless communication between all involved parties, (2) survivors need to demonstrate sufficient health care self‐efficacy in order to achieve a successful transition, and (3) the survivor‐focused care should include support for survivors’ overall well‐being, including financial and health insurance literacy. Conclusions For parents of AYA CCS, the optimal pediatric to adult care transition model should include mechanisms that facilitate communication between parents, CCS, and survivor‐focused providers while also supporting self‐efficacy and financial literacy as it relates to health insurance.
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Affiliation(s)
- Karim Thomas Sadak
- University of Minnesota Masonic Cancer Center, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Milki Gemeda
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Taiwo O Aremu
- University of Minnesota Masonic Cancer Center, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA.,USC Norris Comprehensive Cancer Center, Los Angeles, California, USA.,Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eileen Harwood
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jude Mikal
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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5
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Davies JP, McGill BC, Sansom-Daly UM, Wakefield CE, Kelly DM. "This Is the First Time I've Talked About This": Considerations When Conducting Qualitative Research Interviews with Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:540-548. [PMID: 33393866 DOI: 10.1089/jayao.2020.0122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Qualitative research is a useful and important way to describe and analyze the experiences of adolescents and young adults (AYAs) with cancer. However, undertaking qualitative research with AYAs living with, or beyond, a cancer diagnosis requires careful planning and a well-informed approach for participants with a high level of vulnerability and who are at a crucial stage developmentally. This article reflects on the challenges of including AYAs with cancer between the ages of 16 and 25 years in qualitative research. By drawing on each author's own experiences of engaging in qualitative research interviews with AYAs with cancer, the article provides suggestions regarding how best to manage challenges and yield valuable data describing their experiences. Insights that are shared between qualitative researchers in this field may assist in preparing for the challenges posed by conducting qualitative research with this group and may help researchers to manage this activity successfully.
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Affiliation(s)
- Jane P Davies
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Daniel M Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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6
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The association of health status and cancer history of young adult survivors of childhood cancer with parental accompaniment to survivorship clinic visits. Support Care Cancer 2020; 29:1565-1573. [PMID: 32734393 DOI: 10.1007/s00520-020-05653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Adult childhood cancer survivors are frequently accompanied by a parent to survivorship clinic. From clinical evaluations among young adult survivors of childhood cancer we aimed to (1) investigate the association between accompaniment and the survivors' health complexity; and (2) determine whether accompaniment is associated with adherence to recommended surveillance tests and follow-up in clinic. METHODS This was a cross-sectional study of all patients ≥ 18 years old at their first visit to the regional Yale Childhood Cancer Survivorship Clinic from 2003 to 2018. Patients underwent standardized evaluations for medical, neurocognitive, and emotional late effects of therapy; individuals accompanying patients were documented. RESULTS The 168 patients were a median of 12.0 (range: 0-17.9) years at diagnosis and 22.7 (range: 18.1-39.9) years at evaluation, and 45.8% were accompanied by a parent. In multivariable analyses, 18.0-24.99 years vs. 25.0-39.99 years at visit (OR = 3.43, p = 0.022) and central nervous system (CNS) tumor diagnosis (OR = 6.09 vs. leukemia/lymphoma diagnosis, p = 0.010) were significantly associated with parental accompaniment. Accompaniment was not associated with number and severity of medical late effects, neurocognitive impairment, or emotional distress. Accompaniment was not associated with completed surveillance tests or a clinic follow-up within 2 years. CONCLUSION Forty-six percent of survivors were accompanied by a parent, and accompaniment was not associated with survivor health status. Accompaniment was not associated with adherence to recommended surveillance tests or clinic follow-up.
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7
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Motlagh ME, Mirzaei-Alavijeh M, Hosseini SN. Information Needs Assessment among Parents of Children with Cancer. Asian Pac J Cancer Prev 2019; 20:1865-1870. [PMID: 31244311 PMCID: PMC7021609 DOI: 10.31557/apjcp.2019.20.6.1865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/09/2029] [Indexed: 11/25/2022] Open
Abstract
Background: Parents of children with leukemia should be receiving an extensive amount of information about the care of their child; the aim of this study was to determine the parents’ information needs of children with leukemia. Methods: A cross-sectional study design was used to describe medical, physical, mental and lifestyle information needs among parents of children with leukemia. 209 parents of children diagnosed with leukemia in the west of Iran, during winter 2018, voluntarily participated in individual interviews. Data were analyzed by SPSS version 16 using t-test, One-way ANOVA and bivariate correlations statistical tests at 95% significant level. Results: The mean age of participants was 39.45 years [95% CI: 38.35, 40.55], ranged from 27 to 58 years. Participants achieved 55.6% score of information needs. There was a significant relationship between higher education level (P< 0.001), better economic status (P=0.008) and more family size member (P=0.003) with information needs. Conclusion: Findings suggest that parents of children with leukemia need the information to learn how to take care of their childhood and could be useful for guiding implementers to planning and implement effective programs to promotion information of parents towards children with cancer.
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Affiliation(s)
- Mohammad Esmail Motlagh
- Department of Pediatrics, Faculty Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Mirzaei-Alavijeh
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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8
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Musiol K, Bulska W, Brożek P, Oślizło B, Ryzak S, Dubiel J, Sobol-Milejska G. Quality of life in survivors of childhood brain tumour and the association of children's diseases on quality of their parents life. Psychooncology 2019; 28:1088-1095. [PMID: 30875709 DOI: 10.1002/pon.5061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Evaluation of children's quality of life (QoL) after finished brain tumour treatment and the association of children's diseases on quality of their parents' life. METHODS The study group was consisted of 46 children after brain tumour treatment (aged 4, 5, to 29 years old). The control group was composed of 104 students of primary, secondary, and high schools. One hundred fifty (104 + 46) parents were included in the study. Standardised QoL questionnaires (PEDsQL-4.0, WHOQOL-BREF) were used. Survivors' QoL was assessed from patients' and their parents' point of view, also the association of children's diseases on quality of their parents' life was estimated. RESULTS QoL of children after brain tumour treatment was lower than in the control group according to the children (P < 0.001) and their parents (P < 0.001). The survivors worst rated their ability to social functioning (P < 0.0010) and physical functioning (P < 0.001) in comparison with self-assessment of healthy children. According to their parents, the functioning of children in all zones was worse than in the control group, mostly in social (P < 0.001) and physical sphere (P < 0.001), too. QoL of children with low-grade tumour was comparable with QoL of children with high-grade tumour). QoL of survivors' caregivers in study was higher than QoL of parents of control groups (P = 0.023). CONCLUSIONS The quality of patients' life after brain tumour treatment is lower in comparison with healthy children. QoL of the parents of survivor is higher than the QoL of healthy children parents. The assessment of QoL of children after brain tumour treatment should be an inherent element of health monitoring.
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Affiliation(s)
- Katarzyna Musiol
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice
| | - Weronika Bulska
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice
| | - Paulina Brożek
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice
| | - Barbara Oślizło
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice
| | - Stella Ryzak
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice
| | | | - Grażyna Sobol-Milejska
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, Katowice
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9
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Shay LA, Schmidt S, Cornell SD, Parsons HM. "Making My Own Decisions Sometimes": A Pilot Study of Young Adult Cancer Survivors' Perspectives on Medical Decision-Making. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1341-1346. [PMID: 28752237 PMCID: PMC5787043 DOI: 10.1007/s13187-017-1256-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to provide a better understanding of the medical decision-making preferences and experiences of young adult survivors of pediatric, adolescent, and young adult cancers. We conducted key informant interviews and a cross-sectional mailed survey with young adult survivors (currently aged 18-39 years) of pediatric, adolescent, and young adult cancers in South Texas. Of the responding survivors, almost all wanted to be actively involved in medical decision-making, but preferences regarding family and doctor involvement varied. In open-ended responses, the most commonly reported concerns related to medical decision-making were feelings of uncertainty and fear of receiving bad news. Survivors reported that they desired more information in order to feel better about medical decision-making. Due to the variety of preferences regarding decision-making and who to include in the process, physicians should be prepared to ask and accommodate patients regarding their decision-making preferences.
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Affiliation(s)
- L Aubree Shay
- UTHealth School of Public Health in San Antonio, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, USA.
| | - Susanne Schmidt
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Stephanie D Cornell
- UTHealth School of Public Health in San Antonio, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, USA
- University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Helen M Parsons
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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10
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Staba Hogan MJ, Ross WL, Balsamo L, Mitchell HR, Kadan-Lottick NS. Parental perception of child vulnerability in childhood cancer survivors. Pediatr Blood Cancer 2018; 65:e27364. [PMID: 30024087 DOI: 10.1002/pbc.27364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/08/2018] [Accepted: 06/23/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parents' perception of their children's vulnerability to illness following cancer treatment is largely unknown, but is important to understand given known challenges of transitioning survivors to postcancer care. We investigated the frequency of and factors associated with perceived vulnerability by parents of childhood cancer survivors attending a regional survivorship clinic. PROCEDURE This cohort study was offered to all parents of pediatric patients (currently ≤18 years) attending the Yale childhood cancer survivorship clinic January 2010 to October 2016 who were ≥1 year postcurative cancer therapy. Participating parents (one per patient) completed the standardized Child Vulnerability Scale at the beginning of the clinic visit (cutoff score ≥10 for perceived vulnerability). Patient sociodemographics, cancer history, and posttherapy complications were abstracted from medical records. RESULTS Overall, 116 parents participated (98% participation rate) consisting of 89% mothers; survivors were 46% female, had a current mean age of 12.7 ± 3.9 years, and were a mean of 6.4 ± 3.8 years posttherapy. Twenty-eight percent (n = 33) of parents perceived their children as vulnerable. Survivor sociodemographics (age, sex, race/ethnicity, family income, insurance, parental marital status, number of siblings), cancer diagnosis, years off-therapy, survivorship visit number, treatment intensity, and late complications (number, type, severity) were not associated with perception of vulnerability. CONCLUSIONS A sizeable proportion of parents continue to perceive their children as vulnerable even years after cancer therapy completion independent of current health status or past cancer history. Our data suggest the need to educate all parents of childhood cancer survivors regarding health risk, including those at lower risk for late complications.
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Affiliation(s)
- Mary-Jane Staba Hogan
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Wilhelmenia L Ross
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Lyn Balsamo
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | | | - Nina S Kadan-Lottick
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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11
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Parent-perceived Facilitators in the Transition of Care for Young Adult Survivors of Childhood Cancer. J Pediatr Hematol Oncol 2017; 39:e377-e380. [PMID: 28085750 DOI: 10.1097/mph.0000000000000765] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most childhood cancer survivors need life-long care with specialized late-effects surveillance and screening. As these children age into adulthood, it is imperative to continue their survivor-focused care. To do so, health care systems must be prepared to care for this growing and aging population. This includes creating models of care that take into account the needs and desires of all key stakeholders: survivors, parents, pediatric providers, and adult providers. This clinical observation describes that parents desire comprehensive and highly accessible survivorship care that promotes survivor independence; yet, they also want to have a central role in their child's survivorship care.
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12
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Lehmann V, Hagedoorn M, Gerhardt CA, Keim MC, Guthrie L, Sanderman R, Tuinman MA. Memories of Parent Behaviors and Adult Attachment in Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:134-141. [DOI: 10.1089/jayao.2016.0033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vicky Lehmann
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, Ohio
- The Ohio State University, Department of Pediatrics, Columbus, Ohio
| | - Mariët Hagedoorn
- University Medical Center Groningen (UMCG), University of Groningen, Healthy Psychology Research Section, Groningen, The Netherlands
| | - Cynthia A. Gerhardt
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, Ohio
- The Ohio State University, Department of Pediatrics, Columbus, Ohio
| | - Madelaine C. Keim
- The Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, Ohio
| | | | - Robbert Sanderman
- University Medical Center Groningen (UMCG), University of Groningen, Healthy Psychology Research Section, Groningen, The Netherlands
| | - Marrit A. Tuinman
- University Medical Center Groningen (UMCG), University of Groningen, Healthy Psychology Research Section, Groningen, The Netherlands
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13
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Woodgate RL. The Importance of Being There: Perspectives of Social Support by Adolescents with Cancer. J Pediatr Oncol Nurs 2016; 23:122-34. [PMID: 16624888 DOI: 10.1177/1043454206287396] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescents with cancer are confronted with many challenges. The extent to which they are able to deal with such challenges appears to be partly contingent on a positive strong social support system. In this article, the author describes findings specific to the sources of social support that 15 adolescents with cancer found to be most important in getting them through the cancer experience. Data were collected as part of a longitudinal qualitative interpretive study and involved individual interviews, focus group interviews, and participant observation as the main sources of data. The relationships that adolescents maintained with their nuclear families, health care team members, and special friends were the 3 main supportive relationships in the adolescents'lives. The act of others “being there” was seen by the adolescents as the key element of a supportive relationship and involved 6 main behaviors. Although the 3 key supportive relationships were essential in helping adolescents get through cancer, these relationships were at times a source of stress for adolescents.
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Affiliation(s)
- Roberta Lynn Woodgate
- department of Pediatrics and Child Health, University of Manitoba, R3T 2N2, Winnipeg, Manitoba, Canada.
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14
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Follow-up care of young childhood cancer survivors: attendance and parental involvement. Support Care Cancer 2016; 24:3127-38. [PMID: 26922584 DOI: 10.1007/s00520-016-3121-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/09/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Despite recommendations, only a proportion of long-term childhood cancer survivors attend follow-up care. We aimed to (1) describe the follow-up attendance of young survivors aged 11-17 years; (2) describe the parental involvement in follow-up, and (3) investigate predictors of follow-up attendance and parental involvement. METHODS As part of the Swiss Childhood Cancer Survivor Study, a follow-up questionnaire was sent to parents of childhood cancer survivors aged 11-17 years. We assessed follow-up attendance of the child, parents' involvement in follow-up, illness perception (Brief IPQ), and sociodemographic data. Clinical data was available from the Swiss Childhood Cancer Registry. RESULTS Of 309 eligible parents, 189 responded (67 %; mean time since diagnosis 11.3 years, range 6.8-17.2) and 75 % (n = 141) reported that their child still attended follow-up. Of these, 83 % (n = 117) reported ≥1 visit per year and 17 % (n = 23) reported <1 visit every year. Most survivors saw pediatric oncologists (n = 111; 79 % of 141), followed by endocrinologists (n = 24, 17 %) and general practitioners (n = 22, 16 %). Most parents (92 %) reported being involved in follow-up (n = 130). In multivariable and Cox regression analyses, longer time since diagnosis (p = 0.025) and lower perceived treatment control (assessed by IPQ4: how much parents thought follow-up can help with late effects; p = 0.009) were associated with non-attendance. Parents' overall information needs was significantly associated with parental involvement in the multivariable model (p = 0.041). CONCLUSION Educating survivors and their parents on the importance and effectiveness of follow-up care might increase attendance in the longer term.
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Adult childhood cancer survivors' narratives of managing their health: the unexpected and the unresolved. J Cancer Surviv 2016; 10:711-25. [PMID: 26833205 PMCID: PMC4920835 DOI: 10.1007/s11764-016-0517-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/18/2016] [Indexed: 12/16/2022]
Abstract
Purpose Currently, 80 % of children diagnosed with cancer will be cured. However, many of these survivors go on to develop long-term health problems or late effects related to their previous cancer and therapy and require varying degrees of lifelong follow-up care. The purpose of this study was to identify the different ways that adult survivors of childhood cancer manage their medical and psychological challenges. Methods Data from in-depth interviews with 30 adult survivors of a childhood cancer (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, thematic narrative analysis methods. Results The survivors had not expected the medical, psychological, and social challenges that arose over time and that often remained unresolved. Five narrative themes revealed distinct ways that survivors managed their health challenges: (1) trying to forget cancer, (2) trusting the system to manage my follow-up care, (3) being proactive about my health, (4) stumbling from one problem to the next, and (5) struggling to find my way. Conclusions Variation exists in the ways in which childhood cancer survivors frame their health, their perceived significance of health challenges, strategies used to manage health, interactions with healthcare professionals and the health system, and parental involvement. Implications for Cancer Survivors This research provides novel insights that can be used to inform the development of patient-centered health services that promote the assessment and tailoring of care to the diverse ways survivors enact their agency, as well as their psychoeducational coping styles, therapeutic relationship needs, and information needs.
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Gardner MH, Mrug S, Schwebel DC, Phipps S, Whelan K, Madan-Swain A. Demographic, medical, and psychosocial predictors of benefit finding among caregivers of childhood cancer survivors. Psychooncology 2015; 26:125-132. [PMID: 26489522 DOI: 10.1002/pon.4014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/15/2015] [Accepted: 09/25/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a growing body of literature examining benefit finding, or finding positive outcomes in the face of adversity, among both adults and children with chronic conditions, and to some degree among caregivers. This study examined demographic, medical, and psychosocial predictors of greater benefit finding specifically among caregivers of childhood cancer survivors. METHODS Caregivers of children who had completed treatment for cancer (n = 83) completed measures assessing child and caregiver demographic information and caregiver coping (active, acceptance, emotion-focused, and avoidant), optimism, social support, caregiving burden, posttraumatic stress symptoms, illness impact (how much caregivers feel impacted by their child's illness in various domains), and benefit finding (positive outcomes). RESULT Regression analyses indicated that positive spiritual coping, optimism, and illness impact uniquely predicted overall benefit finding for caregivers of childhood cancer survivors. CONCLUSION Results point to adaptive tendencies that are associated with finding benefits when caring for a childhood cancer survivor and suggest potential avenues for intervention among this population. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Molly H Gardner
- Departments of Hematology and Oncology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 201, Birmingham, AL, 35294, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 201, Birmingham, AL, 35294, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kimberly Whelan
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue S., Lowder Building 512, Birmingham, AL, 35233, USA
| | - Avi Madan-Swain
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, 1600 7th Avenue S., Lowder Building 512, Birmingham, AL, 35233, USA
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Vetsch J, Rueegg CS, Gianinazzi ME, Bergsträsser E, von der Weid NX, Michel G. Information needs in parents of long-term childhood cancer survivors. Pediatr Blood Cancer 2015; 62:859-66. [PMID: 25663499 DOI: 10.1002/pbc.25418] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/06/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Parents' knowledge about cancer, treatment, potential late effects and necessary follow-up is important to reassure themselves and motivate their child to participate in regular follow-up. We aimed to describe (i) parents' perception of information received during and after treatment; (ii) parents' current needs for information today, and to investigate; and (iii) associations between information needs and socio-demographic and clinical characteristics. METHODS As part of the Swiss Childhood Cancer Survivor Study, a follow-up questionnaire was sent to parents of survivors, diagnosed < 16 years and after 1990, and aged 11-17 years at study. We assessed parents' perception of information received and information needs, concerns about consequences of the cancer and socio-demographic information. Information on clinical data was available from the Swiss Childhood Cancer Registry. RESULTS Of 309 eligible parents, 189 responded (67%; mean time since diagnosis: 11.3 years, SD = 2.5). Parents perceived to have received verbal information (on illness: verbal 91%, written 40%; treatment: verbal 88%, written 46%; follow-up: verbal 85% written 27%; late effects: verbal 75%, written 19%). Many parents reported current information needs, especially on late effects (71%). The preferred source was written general (28%) or verbal information (25%), less favored was online information (12%). Information needs were associated with migration background (P = 0.039), greater concerns about consequences of cancer (P = 0.024) and no information received (P = 0.035). CONCLUSION Parents reported that they received mainly verbal information. However, they still needed further information especially about possible late effects. Individual long-term follow-up plans, including a treatment summary, should be provided to each survivor, preferably in written format.
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Affiliation(s)
- Janine Vetsch
- Department of Health Sciences & Health Policy, University of Lucerne, Switzerland
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Doshi K, Kazak AE, Hocking MC, DeRosa BW, Schwartz LA, Hobbie WL, Ginsberg JP, Deatrick J. Why mothers accompany adolescent and young adult childhood cancer survivors to follow-up clinic visits. J Pediatr Oncol Nurs 2014; 31:51-7. [PMID: 24451909 DOI: 10.1177/1043454213518111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Parents often accompany adolescent and young adult (AYA) pediatric cancer survivors to follow-up oncology clinic visits and remain involved in their care, although little is known about their reasons for doing so. METHOD This mixed methods (qualitative-quantitative) study of 76 mothers of AYA survivors of childhood cancer uses content analysis and logistic regression to identify and explore reasons mothers provided for coming to the visit. Demographic and treatment data are examined as potentially explanatory factors. RESULTS Ten reasons (in decreasing order of frequency) were derived: Concern for Child's Health and Well-Being, Practical Support, Transportation, Familial Experience, General Support, Companionship, Personal Interest in Follow-up Care, Characteristics of their Child, Emotional Support, and Parental Duty. The reasons were not related to demographic or treatment factors. CONCLUSION Mothers accompany AYAs to survivorship clinic for both maternal/family-focused and survivor-focused reasons that can be incorporated in survivorship and transition care to reflect ongoing communications among survivors, parents, and health care teams.
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Affiliation(s)
- Kinjal Doshi
- 1University of Pennsylvania, Philadelphia, PA, USA
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Schwartz LA, Kazak AE, Derosa BW, Hocking MC, Hobbie WL, Ginsberg JP. The role of beliefs in the relationship between health problems and posttraumatic stress in adolescent and young adult cancer survivors. J Clin Psychol Med Settings 2012; 19:138-46. [PMID: 21964825 DOI: 10.1007/s10880-011-9264-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In addition to the potential for ongoing health concerns, adolescent and young adult (AYA) childhood cancer survivors frequently report posttraumatic stress symptoms (PTSS). The current study examines whether beliefs about health moderate the relationship between the number of health problems and PTSS 2 months later in 140 survivors. Beliefs, as measured by scales of the Health Competence Beliefs Inventory (HCBI), negatively related to PTSS while health problems positively related to PTSS. Three scales of the HCBI-health perceptions, satisfaction with healthcare and cognitive competence--were significant moderators. The relationship between health problems and PTSS was stronger in the presence of less adaptive beliefs. These beliefs represent potentially malleable intervention targets for reducing PTSS in childhood cancer survivors.
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Affiliation(s)
- Lisa A Schwartz
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Hovén EI, Lannering B, Gustafsson G, Boman KK. Persistent impact of illness on families of adult survivors of childhood central nervous system tumors: a population-based cohort study. Psychooncology 2011; 22:160-7. [DOI: 10.1002/pon.2067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Emma I. Hovén
- Karolinska Institutet; Department of Women's and Children's Health; Childhood Cancer Research Unit; Stockholm; Sweden
| | - Birgitta Lannering
- University of Gothenburg; Department of Clinical Sciences, Pediatric Oncology; Gothenburg; Sweden
| | - Göran Gustafsson
- Karolinska Institutet; Department of Women's and Children's Health; Childhood Cancer Research Unit; Stockholm; Sweden
| | - Krister K. Boman
- Karolinska Institutet; Department of Women's and Children's Health; Childhood Cancer Research Unit; Stockholm; Sweden
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DeRosa BW, Kazak AE, Doshi K, Schwartz LA, Ginsberg J, Mao JJ, Straton J, Hobbie W, Rourke MT, Carlson C, Ittenbach RF. Development and validation of the health competence beliefs inventory in young adults with and without a history of childhood cancer. Ann Behav Med 2011; 41:48-58. [PMID: 20936390 DOI: 10.1007/s12160-010-9228-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adolescent and young adult survivors of childhood cancer are a vulnerable population. Health beliefs may be related to necessary follow-up care. PURPOSE This study seeks to develop a measure of health beliefs for adolescents and young adults with and without a history of cancer. METHODS Inductive and deductive methods and focus groups were used to develop the Health Competence Beliefs Inventory. Cancer survivors (n = 138) and comparison participants (n = 130) completed the Health Competence Beliefs Inventory and other measures. Healthcare providers reported current medical problems. RESULTS A series of iterative exploratory factor analyses generated a 21-item four-factor solution: (1) Health Perceptions; (2) Satisfaction with Healthcare; (3) Cognitive Competence; and (4) Autonomy. Survivors reported significantly different Health Competence Beliefs Inventory scale scores than comparisons (p < .05). The Health Competence Beliefs Inventory was associated with beliefs, affect, quality of life, posttraumatic stress symptoms, and medical problems. CONCLUSIONS The Health Competence Beliefs Inventory is a promising measure of adolescent and young adult perceptions of health and well-being.
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Stolley MR, Restrepo J, Sharp LK. Diet and physical activity in childhood cancer survivors: a review of the literature. Ann Behav Med 2010; 39:232-49. [PMID: 20559768 DOI: 10.1007/s12160-010-9192-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Treatment advances have led to a growing population of childhood cancer survivors. Many are at risk for developing treatment-related late effects. Diet and physical activity may affect levels of health risk. A number of papers have examined these behaviors in childhood cancer survivors. The purpose of this study was to provide a review and summary of the published studies in the areas of diet, physical activity, and related interventions among childhood cancer survivors. A systematic search was conducted for studies published prior to October 2009. Descriptive and intervention studies that included survivors of childhood cancers and a measurement of diet and/or physical activity were reviewed. Twenty-six manuscripts met criteria: ten addressed diet; 20 addressed physical activity, and six included intervention studies. Results suggest that childhood cancer survivors engage in health-promoting activities at rates comparable to the general population. Behavioral interventions have mostly targeted physical activity. Results, overall, are not encouraging, due primarily to difficulties recruiting and retaining participants. Although more rigorous studies are needed, recommendations for health-promoting behaviors should be a regular topic of discussion between health care providers and their childhood cancer survivor patients.
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Takken T, van der Torre P, Zwerink M, Hulzebos EH, Bierings M, Helders PJM, van der Net J. Development, feasibility and efficacy of a community-based exercise training program in pediatric cancer survivors. Psychooncology 2009; 18:440-8. [PMID: 19242926 DOI: 10.1002/pon.1484] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to develop a 12-week exercise training program (comprising aerobic and strength exercises), and to study the feasibility and efficacy of this exercise program in children who survived acute lymphoblastic leukemia. SAMPLE AND METHODS A 12-week exercise program was developed and tested for feasibility in nine children who survived cancer. RESULTS From the 16 eligible children for the intervention, 9 participated, while 4 were able to complete the entire program. Feasibility of the program was scored by five children, two of them reported the program as being too demanding. The participating physiotherapists were satisfied with training methodology and training progress. The efficacy of the program on muscle strength, exercise capacity, functional mobility and fatigue showed no significant differences between pre and post training. CONCLUSION In designing a community-based exercise training program, not only the stage of the disease needs to be considered, but more so the age of the children, the variety of exercises, the location of implementation and even more importantly the views and motivation of the parents concerning the execution of an exercise training program. A careful balance between these parameters could lead to a greater adherence and by that, to a better outcome of these programs.
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Affiliation(s)
- Tim Takken
- Department of Pediatric Physical Therapy and Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Hutchinson KC, Willard VW, Hardy KK, Bonner MJ. Adjustment of caregivers of pediatric patients with brain tumors: a cross-sectional analysis. Psychooncology 2009; 18:515-23. [DOI: 10.1002/pon.1421] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gurney JG, Krull KR, Kadan-Lottick N, Nicholson HS, Nathan PC, Zebrack B, Tersak JM, Ness KK. Social outcomes in the Childhood Cancer Survivor Study cohort. J Clin Oncol 2009; 27:2390-5. [PMID: 19224833 DOI: 10.1200/jco.2008.21.1458] [Citation(s) in RCA: 334] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Difficulties with negotiating and achieving desired social outcomes in life may be exacerbated by the experience of childhood cancer, including adverse effects from therapies used to achieve a cure. This review of previous publications from the Childhood Cancer Survivor Study (CCSS) and other relevant literature provides insight into the prevalence of, and risk factors for, poor educational attainment, less than optimal employment status, and interpersonal relationship issues among long-term survivors of childhood cancer. The impacts of emotional health and physical disability on social outcomes are also examined. Study results suggest that childhood cancer survivors generally have similar high school graduation rates, but are more likely to require special education services than sibling comparison groups. Survivors are slightly less likely than expected to attend college, and are more likely to be unemployed and not married as young adults. Cancers and treatments that result in impairment to the CNS, particularly brain tumors, or that impact sensory functioning, such as hearing loss, are associated with greater risk for undesirable social outcomes, as are emotional health problems and physical disability. This review of relevant data from CCSS and other studies provides information on risk factors for social problems into adulthood. A greater understanding of the long-term social impacts from the diagnosis and treatment of childhood cancer is critically important for developing targeted interventions to prevent or ameliorate adverse psychosocial effects.
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Affiliation(s)
- James G Gurney
- Department of Pediatrics, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109, USA.
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Adult survivors of childhood cancer and their parents: experiences with survivorship and long-term follow-up. J Pediatr Hematol Oncol 2008; 30:651-8. [PMID: 18776756 DOI: 10.1097/mph.0b013e31817e4a6a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To compare the perspectives of adult childhood cancer survivors and their parents in terms of: (1) parental involvement in the survivor's healthcare, (2) thoughts and discussion about their own or their son's/daughter's childhood cancer, (3) concern about the survivor's current health status, and (4) perceived benefits of follow-up care. Forty-two adult survivors and their parents completed a semistructured audio-taped interview via the phone responding to a parallel set of questions. Thirty-eight percent of survivors reported that one of their parents attended the adult survivor clinic with them; in 41% of patient-parent dyads the parent expressed more concern than their child about the child's health status; 45% of the parents reported thinking about the cancer experience more often than their child. The results suggest that some parents continue to worry about their child's health status into adulthood, and in turn may choose to stay involved in their adult child's healthcare. Additional research is needed to understand the survivorship needs of the adult survivor and their family. Including parents in important healthcare decisions and discussions may be a consideration when caring for this unique population of patients.
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Abstract
BACKGROUND Although significant progress has been made in identifying long-term sequelae for adult survivors of childhood cancer, comparatively little attention has been paid to the functioning of their parents. In a previous study, we observed that a majority of adult survivors are accompanied to clinic visits by at least 1 parent, suggesting ongoing concern for their children's health. In the current study, we explore psychologic stressors that characterize this population and might account for this finding. PROCEDURE Responses to measures of psychosocial functioning (ie, Brief Symptom Inventory, Impact on Family Scale, Impact of Events Scale, Parent Experience of Child Illness Scale) were compared between 27 parents of adult survivors (mean age=25.6 y) of pediatric cancer and 28 parents of current pediatric cancer patients (mean age=10.2 y) on, or within 1 year of, active treatment. RESULTS Compared with parents of pediatric cancer patients on treatment, parents of adult survivors demonstrated few significant differences in overall psychologic functioning, posttraumatic stress symptoms, and adjustment to the disease experience. Indeed, the 2 groups differed only in their report of objective and family burden (eg, financial cost, time off from work, less time with family members), and in their levels of anger associated with the illness experience. CONCLUSIONS Results suggest that parents who continue to accompany their adult child to clinic may remain psychologically vulnerable many years after the end of treatment, and that the impact of having a child with a life-threatening illness may not diminish even years into the child's survivorship.
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Abrams AN, Hazen EP, Penson RT. Psychosocial issues in adolescents with cancer. Cancer Treat Rev 2007; 33:622-30. [PMID: 17434265 DOI: 10.1016/j.ctrv.2006.12.006] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
Abstract
Cancer in adolescents is uncommon and when it occurs raises a number of unique challenges for both the patient and their families. Adolescence is a period of time of significant physical and emotional changes and a diagnosis of cancer during this time has a major impact on their psychological and physical development. In this review we will look at the psychosocial issues facing adolescents who have cancer. We will address adolescent development, issues related to informed consent and assent, initial responses to the diagnosis of cancer, quality of life and the experience of the adolescent with cancer, psychological adjustment, support systems, body image issues, sexuality, education, hope, and treatment compliance.
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Affiliation(s)
- Annah N Abrams
- Department of Child Psychiatry and Pediatric Hematology-Oncology, Massachusetts General Hospital, Boston, MA 02114, United States.
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