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Twivy E, Griffiths H, Knight MTD. Evaluating end of treatment care of young people with cancer. Clin Child Psychol Psychiatry 2024; 29:661-673. [PMID: 37773596 PMCID: PMC10945980 DOI: 10.1177/13591045231204073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Existing literature implies there may be gaps in post-treatment support for young people with cancer. This service evaluation explored the needs and experiences of young people when ending cancer treatment in a UK children's hospital to inform service provisions. METHODS Semi-structured interviews were conducted with nine young people, aged 13-18 years, who had finished active cancer treatment and were receiving follow-up care. The data was analysed using thematic analysis. RESULTS Four main themes were developed: being in the dark (i.e. limited awareness of what happens when treatment ends); separation from the hospital (i.e. the loss of valued support from staff); consequences of cancer (i.e. managing ongoing psychological and physical effects); and getting back to normal life (i.e. shifting from hospital to everyday life). CONCLUSIONS Recommendations for improving clinical practice were made. Greater preparedness for ending treatment could be achieved by clearly setting out ongoing care arrangements, providing resource packs, having opportunities to mark the end of treatment, and offering peer support. To identify specific post-treatment needs, there should be an end of treatment multidisciplinary review and space for young people to share how they are feeling in follow-up medical appointments.
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Affiliation(s)
- Eve Twivy
- Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, University of Oxford, UK
| | - Helen Griffiths
- Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Matthew TD Knight
- Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, University of Oxford, UK
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Merz S, Friedrich M, Brock H, Leuteritz K, Geue K, Richter D, Mehnert-Theuerkauf A, Sender A. Changes and predictors of social support in adolescent and young adult cancer survivors-Results of a 7-year longitudinal study. Psychooncology 2024; 33:e6282. [PMID: 38282213 DOI: 10.1002/pon.6282] [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: 05/30/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE As social support has been shown to have beneficial effects on coping with cancer, our study aims to close the research gap on perceived social support in adolescent and young adult (AYA) cancer survivors. METHODS AYAs evaluated their perceived positive social support (PS) and detrimental interactions (DI) by completing the Illness-Specific Social Support Scale (ISSS-8) upon completion of acute treatment (t1) as well as 1 year (t2) and 7 years (t6) later. Temporal changes of social support were examined. Sociodemographic, psychological and medical factors were investigated as predictors for PS and DI by using mixed effects models. RESULTS We analyzed data from 319 cancer survivors (74.9% women). At baseline, survivors reported an average score of 13.73 (SD = 2.52) for PS and 3.92 (SD = 2.85) for DI. Average perceived PS changed over time, while DI remained stable. Males, AYAs without a partner and AYAs with clinically meaningful anxiety or depression levels reported fewer PS. Higher effort to cope with the disease and clinically significant anxiety and depression levels were associated with more perceived DI. CONCLUSIONS Existing social networks and perceived social support should be evaluated regularly in AYA-cancer survivorship. The identification and discussion of mental health of AYAs should also be a standard component in survivor consultations both during treatment and follow-up care, as elevated depression and anxiety levels were associated with fewer PS and more perceived DI.
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Affiliation(s)
- Sabrina Merz
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Hannah Brock
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Katja Leuteritz
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Kristina Geue
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Diana Richter
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
| | - Annekathrin Sender
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany (CCCG), Leipzig, Germany
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Yoshida S, Shimizu K, Matsui M, Fujimori M, Uchitomi Y, Horibe K. Preferred Communication with Adolescent and Young Adult Patients Receiving Bad News About Cancer. J Adolesc Young Adult Oncol 2023; 12:561-568. [PMID: 36367705 DOI: 10.1089/jayao.2022.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Several studies have investigated good communication practices with adult patients receiving bad news about cancer. However, while communication preferences may differ between adults and adolescent and young adult (AYA) patients, these preferences have not been determined for AYA patients. The primary endpoint of this study was to describe the communication preferred by AYA patients with cancer. Methods: The study cohort consisted of 15 patients who received a cancer diagnosis at the age of 15-29 years. Patients were recruited at the National Cancer Center Hospital or through "STAND UP!!," an association of AYA patients with cancer. Semistructured interviews were conducted, and content analysis was performed to analyze the data. Results: For the preferred communication of AYA patients, 80 categories were extracted in the following five domains: (1) "Supportive setting," (2) "Method of disclosure of bad news," (3) "Information given," (4) "Emotional support," and (5) "Support for the patient's decision making." Although more than half of the categories extracted were identical to the preferred communication of adult patients, some categories specific to AYA patients were identified that physicians should consider. Preferences specific to AYA patients included mentioning generation-specific social factors, not showing excessive empathy, and communicating in a manner considering their age and cognitive development that supports their decision making. Conclusion: Although physicians should be mindful of the specific preferences of AYA patients, the basic attitude and communication preferences are similar to those of patients of other generations.
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Affiliation(s)
- Saran Yoshida
- Division of Clinical Psychology, Graduate School of Education, Tohoku University, Sendai, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, Cancer Institute Hospital of JFCR, Koto-ku, Japan
| | - Motohiro Matsui
- Department of Pediatric Hematology Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, Institute for Cancer Control, National Cancer Center, Chuo-ku, Japan
| | - Yosuke Uchitomi
- Division of Supportive Care, Survivorship and Translational Research, Institute for Cancer Control, National Cancer Center, Chuo-ku, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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von Werthern M, Grigorakis G, Sweet R, Soon K. The Continuity of Cancer: Children and Adolescent's Experiences of Ending Cancer Treatment - A Systematic Review. QUALITATIVE HEALTH RESEARCH 2022; 32:2006-2018. [PMID: 36190313 DOI: 10.1177/10497323221128860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As the research and treatment of childhood cancer steadily progresses, so has the interest in children's needs, not only throughout such treatment but also following completion. Whilst there is increased literature focussing on the long-term psychosocial impact of treatment completion, little is currently known about how children and young people (CYP) experience the more immediate end of their cancer treatment. The current review seeks to examine CYP's experiences of the end of their cancer treatment. Sixteen studies were retrieved using a systematic search strategy across five databases, all of which used qualitative methodology. Thematic synthesis was chosen to analyse the data. Four overarching themes were generated, which encompassed 'the continuity of cancer', 'ambivalence of needs', 'making sense of the cancer experience' and 'sense of self following the ending'. The end of treatment is a time of complexity for CYP, yet it is currently largely overlooked. In order to scaffold these endings for CYP, increased emphasis and thought needs to be placed on the end of treatment and the support that is provided within it.
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Affiliation(s)
| | | | | | - Kristina Soon
- 4919University College London, London, UK
- 4956Great Ormond Street Hospital, London, UK
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5
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Cheung CK, Norlander MG, Vest AN, Thomas BN, Zebrack BJ. A Thin Line Between Helpful and Harmful Internet Usage: Embodied Research on Internet Experiences Among Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2022; 11:478-485. [PMID: 34882036 PMCID: PMC11071103 DOI: 10.1089/jayao.2021.0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to expand upon findings from a prior Delphi study of adolescent and young adults' (AYAs') preferences for cancer resources. Utilizing an embodied approach, this study intended to elucidate a deeper and nuanced understanding of the expressed benefits and risks of engaging in cancer-related online interactions. Methods: Using Gale et al.'s framework method for qualitative, multidisciplinary health research and Thanem and Knights's embodied research methods for the social sciences, an investigative team of embodied researchers (AYA cancer patients turned researchers) conducted semistructured in-depth interviews with AYA cancer patients (n = 10) diagnosed between ages 15 and 39 years. To generate themes, researchers identified commonalities and differences within the qualitative data, and indexed codes according to the agreed analytic framework. Furthermore, by fully engaging with personal reflexivity, bracketing, and analytic memos across data collection and analysis, the investigative team elucidated benefits and risks of embodied research. Results: Findings impart evidence on AYAs' needs for internet-based content at the time of cancer diagnosis, use of the internet to fulfill cancer-related needs, perception of gaps in online cancer resources, and advice to other AYA cancer patients accessing internet-based information and support. Content analysis of interview data on participants' descriptions of personal engagement with the internet revealed beneficial themes of empowerment and harmful themes of fear-inducing consequences. Conclusions: In our rapidly evolving context of postpandemic internet reliance, developers of online cancer content should prioritize and respond to the nuanced vulnerabilities of AYAs. Future research must include socioeconomically disadvantaged participants to better understand practical challenges and promote health equity.
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Affiliation(s)
| | | | - Adriana N. Vest
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Bria N. Thomas
- Loyola University Maryland, Department of Biology and Department of Psychology, Baltimore, Maryland, USA
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Pettit T, Proffit E, Reid J, Dobinson H, Waugh V, Sue L, Vincent T, McMillan S, Hemmaway C, Kilpatrick K, Wilding E, Watson H, Ballantine K. "I Don't Have to be Sick to Still Be Worthy": The Barriers Experienced by Adolescent and Young Adult Cancer Survivors in New Zealand. J Adolesc Young Adult Oncol 2022. [PMID: 35917507 DOI: 10.1089/jayao.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To identify the spectrum and nature of survivorship barriers experienced by New Zealand's adolescent and young adult (AYA) cancer survivor population. In addition, we explore associations between survivorship barriers and sociodemographic characteristics, cancer type, and day-to-day happiness following the end of treatment. Methodology: Participants were recruited for the online survey from AYA cancer service patient databases. Eligibility criteria included: aged 12-24 years at diagnosis, diagnosed between 2010 and 2019, and completed treatment at least one year prior. The analysis focused on 11 barriers (domains, issues, or concerns) which respondents may have faced during survivorship. Results: Two hundred and eighteen AYA survivors participated in the study. The mean number of impactful survivorship barriers was 2.5 (standard deviation 1.7), with 13 respondents (6.0%) reporting no barriers of concern and 31 (14.2%) reporting 5 or more. A higher number of impactful barriers was associated with lower day-to-day happiness (r = -0.34, p ≤ 0.001). The most commonly identified impactful survivorship barriers were mental health (50.0% of respondents), physical health (43.1%), thinking and memory (33.0%), education and work (27.1%), social life (26.1%), and fertility (22.5%). Subgroup analysis identified significant differences according to gender, age at diagnosis, tumor group, ethnicity, and time since diagnosis. Poor access to health care and unmet needs were common themes. Positive impacts, particularly with regards to family relationships, were also identified. Conclusion: These results will inform initiatives to improve AYA survivorship care in New Zealand. Gaps in service delivery and funding will need to be overcome by utilizing innovative strategies and broad sector engagement.
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Affiliation(s)
- Tristan Pettit
- Children's Haematology Oncology Centre, Waipapa Hospital, Christchurch, New Zealand
| | - Ellyn Proffit
- Midland AYA Cancer Services, Waikato Hospital, Hamilton, New Zealand
| | - Julia Reid
- Department of Paediatrics and Child Health, Wellington Regional Hospital, Wellington, New Zealand
| | - Hazel Dobinson
- Department of Paediatrics and Child Health, Wellington Regional Hospital, Wellington, New Zealand
| | - Val Waugh
- Southern Blood & Cancer Service, Dunedin Hospital, Dunedin, New Zealand
| | - Louise Sue
- Canterbury AYA Cancer Services, Waipapa Hospital, Christchurch, New Zealand
| | - Tracey Vincent
- Auckland & Northland AYA Cancer Services, Auckland City Hospital, Auckland, New Zealand
| | - Simone McMillan
- Auckland & Northland AYA Cancer Services, Auckland City Hospital, Auckland, New Zealand
| | - Claire Hemmaway
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Kate Kilpatrick
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Eleanor Wilding
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Heidi Watson
- AYA Cancer Network Aotearoa, Auckland, New Zealand
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7
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Psychosocial Needs and Preferences for Care among Adolescent and Young Adult Cancer Patients (Ages 15–39): A Qualitative Study. Cancers (Basel) 2022; 14:cancers14030710. [PMID: 35158975 PMCID: PMC8833451 DOI: 10.3390/cancers14030710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022] Open
Abstract
Simple Summary Adolescents and young adults (AYAs) are a unique population: they are a diverse group between the ages of 15–39 years with distinct needs and experience numerous developmental milestones during this age range. Notably, AYAs have faced worse outcomes in cancer care, both with shorter survival and worse quality of life compared to children and older adults. Understanding AYAs’ psychosocial, communication and informational needs is crucial to addressing this disparity and improving cancer care delivery. By hearing directly from AYAs, we are able to capture nuances of their experiences and provide clinical recommendations to healthcare providers involved in the care of AYAs with cancer. This study specifically interviewed AYAs with cancer to understand their perspectives, identify needs and to develop recommendations for cancer care delivery and accommodations across the cancer experience. Abstract Adolescents and young adults (AYAs) require a multidisciplinary approach to cancer care due to their complex biopsychosocial situations and varied developmental maturity. Currently, age and diagnosis determine referral to pediatric or adult oncology, with differing treatment paradigms and service utilization patterns, contributing to suboptimal improvements in outcomes. Understanding the unique perspectives of AYAs is essential to designing patient-centered AYA services. Thus, we conducted six focus groups with AYAs (n = 25) treated by medical or pediatric oncologists to evaluate: (1) the unique experiences of cancer care as an AYA; (2) AYA-specific information needs and communication preferences; and (3) recommendations for service provision, delivery and accommodations for AYAs. Transcripts were analyzed using inductive thematic content analysis and identified six major themes to inform clinically-actionable recommendations and the development of a patient-reported outcome measure: (1) AYAs experience social isolation and loss of independence; (2) AYAs have an uncertain sense of the future and need conversations around survivorship and long-term and late effects; (3) AYAs desire greater control over discussions with their care team; (4) AYAs need additional navigational and social/caregiver supports; (5) AYAs prefer an inclusive AYA space in the hospital; and (6) LGBTQ+ patients experience distinct concerns as AYA cancer patients. These will form the basis for specific and tailored clinical recommendations to improve AYA cancer care delivery.
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Taylor RM, Fern LA, Barber J, Gibson F, Lea S, Patel N, Morris S, Alvarez-Galvez J, Feltbower R, Hooker L, Martins A, Stark D, Raine R, Whelan JS. Specialist cancer services for teenagers and young adults in England: BRIGHTLIGHT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
When cancer occurs in teenagers and young adults, the impact is far beyond the physical disease and treatment burden. The effect on psychological, social, educational and other normal development can be profound. In addition, outcomes including improvements in survival and participation in clinical trials are poorer than in younger children and older adults with similar cancers. These unique circumstances have driven the development of care models specifically for teenagers and young adults with cancer, often focused on a dedicated purpose-designed patient environments supported by a multidisciplinary team with expertise in the needs of teenagers and young adults. In England, this is commissioned by NHS England and delivered through 13 principal treatment centres. There is a lack of evaluation that identifies the key components of specialist care for teenagers and young adults, and any improvement in outcomes and costs associated with it.
Objective
To determine whether or not specialist services for teenagers and young adults with cancer add value.
Design
A series of multiple-methods studies centred on a prospective longitudinal cohort of teenagers and young adults who were newly diagnosed with cancer.
Settings
Multiple settings, including an international Delphi study of health-care professionals, qualitative observation in specialist services for teenagers and young adults, and NHS trusts.
Participants
A total of 158 international teenage and young adult experts, 42 health-care professionals from across England, 1143 teenagers and young adults, and 518 caregivers.
Main outcome measures
The main outcomes were specific to each project: key areas of competence for the Delphi survey; culture of teenagers and young adults care in the case study; and unmet needs from the caregiver survey. The primary outcome for the cohort participants was quality of life and the cost to the NHS and patients in the health economic evaluation.
Data sources
Multiple sources were used, including responses from health-care professionals through a Delphi survey and face-to-face interviews, interview data from teenagers and young adults, the BRIGHTLIGHT survey to collect patient-reported data, patient-completed cost records, hospital clinical records, routinely collected NHS data and responses from primary caregivers.
Results
Competencies associated with specialist care for teenagers and young adults were identified from a Delphi study. The key to developing a culture of teenage and young adult care was time and commitment. An exposure variable, the teenagers and young adults Cancer Specialism Scale, was derived, allowing categorisation of patients to three groups, which were defined by the time spent in a principal treatment centre: SOME (some care in a principal treatment centre for teenagers and young adults, and the rest of their care in either a children’s or an adult cancer unit), ALL (all care in a principal treatment centre for teenagers and young adults) or NONE (no care in a principal treatment centre for teenagers and young adults). The cohort study showed that the NONE group was associated with superior quality of life, survival and health status from 6 months to 3 years after diagnosis. The ALL group was associated with faster rates of quality-of-life improvement from 6 months to 3 years after diagnosis. The SOME group was associated with poorer quality of life and slower improvement in quality of life over time. Economic analysis revealed that NHS costs and travel costs were similar between the NONE and ALL groups. The ALL group had greater out-of-pocket expenses, and the SOME group was associated with greater NHS costs and greater expense for patients. However, if caregivers had access to a principal treatment centre for teenagers and young adults (i.e. in the ALL or SOME groups), then they had fewer unmet support and information needs.
Limitations
Our definition of exposure to specialist care using Hospital Episode Statistics-determined time spent in hospital was insufficient to capture the detail of episodes or account for the variation in specialist services. Quality of life was measured first at 6 months, but an earlier measure may have shown different baselines.
Conclusions
We could not determine the added value of specialist cancer care for teenagers and young adults as defined using the teenage and young adult Cancer Specialism Scale and using quality of life as a primary end point. A group of patients (i.e. those defined as the SOME group) appeared to be less advantaged across a range of outcomes. There was variation in the extent to which principal treatment centres for teenagers and young adults were established, and the case study indicated that the culture of teenagers and young adults care required time to develop and embed. It will therefore be important to establish whether or not the evolution in services since 2012–14, when the cohort was recruited, improves quality of life and other patient-reported and clinical outcomes.
Future work
A determination of whether or not the SOME group has similar or improved quality of life and other patient-reported and clinical outcomes in current teenage and young adult service delivery is essential if principal treatment centres for teenagers and young adults are being commissioned to provide ‘joint care’ models with other providers.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- National Cancer Research Institute, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Stark
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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"We're on a Merry-Go-Round": Reflections of Patients and Carers after Completing Treatment for Sarcoma. ACTA ACUST UNITED AC 2021; 28:3003-3014. [PMID: 34436029 PMCID: PMC8395482 DOI: 10.3390/curroncol28040263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/25/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Abstract
Sarcoma is a rare cancer that has a significant impact on patients’ and carers’ quality of life. Despite this, there has been a paucity of research exploring the diverse experiences of patients and carers following sarcoma treatment. The aim of this study was to explore patients’ and carers’ reflections on life after treatment for sarcoma. A qualitative research design with a social constructionist epistemology was used. Participants included patients previously treated for sarcoma (n = 21) and family carers of patients treated for sarcoma (n = 16). Participants completed semi-structured interviews which were analysed using thematic analysis. Three primary themes were identified: “This journey is never going to be over”, “But what happens when I am better?”, and finding a silver lining. Participants represented sarcoma as having a long-term, and sometimes indefinite, threat on their life that they had limited control over. Conclusions: This study highlight the heterogeneous and ongoing needs of sarcoma survivors and their families. Patients and carers strove to translate their experiences in a meaningful way, such as by improving outcomes for other people affected by sarcoma. Parental carers in particular attempted to protect the patient from the ongoing stress of managing the disease.
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10
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Exploring Young People's Experience of Ending Active Cancer Treatment: When the "Little Cancer Treatment Bubble" Pops. Cancer Nurs 2021; 44:288-294. [PMID: 32195707 DOI: 10.1097/ncc.0000000000000798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The end of active cancer treatment is described as a stressful period for adolescents and young adults (AYAs). However, research evidence describing the experience of AYAs as they transition from active treatment into follow-up care is scarce. OBJECTIVE We aimed to understand AYAs' experiences within the first 12 months of ending active treatment. METHODS Data were collected using semistructured interviews, which were digitally recorded and transcribed verbatim. Qualitative analysis of transcripts was used to identify key themes/subthemes. RESULTS Eleven AYAs (8 female participants), diagnosed with cancer aged 17 to 25 years and 19 to 26 years at point of interview, participated. At time of interview, 7 were within 6 months of treatment completion, and in 4 participants, treatment ended 6 to 12 months prior. Three main themes were identified: (1) challenges of social reintegration and self-identity, (2) expectations versus the lived experience of ending treatment, and (3) sudden loss of the safe "bubble" of treatment. CONCLUSIONS Adolescents and young adults were underprepared for and challenged by the unexpected emotional and physical consequences of ending active cancer treatment. IMPLICATIONS FOR PRACTICE Young people require information and support to prepare for ending active treatment and reintegration to everyday life. Preparation for the short- and long-term physical, social, and psychological impact of a cancer diagnosis even when treatment ends will assist young people in managing this transition. Further research is required to develop and test interventions to provide timely, structured, and equitable information and support at the end of treatment to better prepare AYAs for the challenges they may face as treatment ends.
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11
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Lea S, Martins A, Fern LA, Bassett M, Cable M, Doig G, Morgan S, Soanes L, Whelan M, Taylor RM. The support and information needs of adolescents and young adults with cancer when active treatment ends. BMC Cancer 2020; 20:697. [PMID: 32723357 PMCID: PMC7388472 DOI: 10.1186/s12885-020-07197-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background The end of active treatment is a period of high stress for young people with cancer, but limited literature exists about their information and support needs during this phase. This study aimed to understand the needs of young people with cancer, how these needs are currently being met, and how best to provide information and support at the end of active treatment. Methods This was a multi-stage, mixed methods study exploring the end of treatment experience from the perspectives of young people, and the healthcare professionals caring for them. Semi-structured interviews were undertaken with healthcare professionals, which informed a survey administered nationally. Subsequently, semi-structured interviews were conducted with young people. These combined results informed a co-design workshop to develop recommendations. Results Telephone interviews were conducted with 12 healthcare professionals and 49 completed the online survey. A total of 11 young people aged 19–26 years (female = 8; 73%) were interviewed. The stakeholder workshop was attended by both healthcare professionals (n = 8) and young people (n = 3). At the end of treatment young people experience numerous ongoing physical issues including pain, fatigue and insomnia; in addition to a range of psychosocial and emotional issues including anxiety, fear of recurrence and isolation. The top three priorities for end of treatment care were: earlier provision and preparation around on-going impact of cancer and cancer treatment; standardised and continued follow-up of young people’s emotional well-being; and development of more information and resources specific to young people. Conclusion The access and availability of appropriate information and sources of support at the end of treatment is variable and inequitable. Young people’s needs would be more effectively met by timely, structured and accessible information, and support provision at the end of treatment to both prepare and enable adaptation across their transition to living with and beyond cancer. This will require both organisational and practical adjustments in care delivery, in addition to a renewed and updated understanding of what the ‘end of treatment’ transition process means.
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Affiliation(s)
- Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Sue Morgan
- Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Louise Soanes
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Teenage Cancer Trust, London, UK
| | | | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, 1st Floor East, 250 Euston Road, London, NW1 2PG, England.
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Pearce S, Whelan J, Kelly D, Gibson F. Renegotiation of identity in young adults with cancer: A longitudinal narrative study. Int J Nurs Stud 2019; 102:103465. [PMID: 31841739 DOI: 10.1016/j.ijnurstu.2019.103465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite increasing international awareness of the impact of cancer on young adults, to date there has been limited in-depth research to understand their experiences following a diagnosis using a qualitative and longitudinal perspective. OBJECTIVES To explore the impact of cancer on young adults' evolving sense of self and identity over one year from the time of diagnosis. In addition, to contribute further to an understanding of innovative research methods used to examine this experience. DESIGN This was a longitudinal narrative study using visual methods and a psychosocial lens. Narrative was used to re-present experiences over time. SETTING AND SAMPLE Recruitment was from a Principal Treatment Centre for Teenagers and Young Adults with Cancer and a Cancer Centre for Adults in the United Kingdom. Total population sampling was used over a six-month period, recruiting 18 young adults aged between 16 and 30, one to three months from a diagnosis of bone cancer, lymphoma or leukaemia. METHODS In depth, free association narrative interviews at three-time points over a year were undertaken. Photographs were used to help with story-telling. Extensive reflexive field notes, debriefing and the use of a psychosocial research group, also formed data sources. Forty interviews were conducted with 18 participants: eight took part in three interviews, six in two interviews and four in one interview. Analysis focused on the holistic 'case' of the individual temporally. In-depth, visual images were analysed from discussion in the narrative text. Through memoing, coding and comparison, themes were developed across all cases and a conceptual framework developed. RESULTS The conceptual framework illustrates the renegotiation of self over time through narrative. This was 'biographically' during young adult development and across 'cancer time'; through the core components of: the inner world, (psyche, emotion and coping); self as embodied; self as relating to others, and self as relating to place. Stories indicated that there was a constant inter- relationship over time between the renegotiation of identity and adaption of biography. CONCLUSIONS The focus in this paper is on 'the temporality of cancer' through the first year from diagnosis, and the juxtaposed process of managing biographical and developmental milestones. The importance of developing health care and research which enables narrative and the patient's voice has been highlighted. It emphasises the need for professionals to 'be with' and 'walk alongside' through the intensity of a biographically and identity changing illness. Using longitudinal narrative, visual & psychosocial methods to describe the impact of a diagnosis of cancer on young adults' sense of biography and identity.
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Affiliation(s)
- S Pearce
- School of Nursing and Midwifery, University of Plymouth, Room 204, 10 Portland Villas, Plymouth PL4 8AA, Devon, UK; Torbay and South Devon Clinical School, Torbay and South Devon NHS Foundation Trust, UK.
| | - J Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - D Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - F Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust and School of Health Science, University of Surrey, Guilford, Surrey, UK.
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Pappot H, Assam Taarnhøj G, Elsbernd A, Hjerming M, Hanghøj S, Jensen M, Boisen KA. Health-Related Quality of Life Before and After Use of a Smartphone App for Adolescents and Young Adults With Cancer: Pre-Post Interventional Study. JMIR Mhealth Uhealth 2019; 7:e13829. [PMID: 31584008 PMCID: PMC6797966 DOI: 10.2196/13829] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/06/2019] [Accepted: 07/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Adolescent and young adult (AYA) patients with cancer are a group with underexplored needs throughout treatment and in survivorship. This missing knowledge can influence their quality of life (QoL). Given this fact, we have developed a smartphone app based on a cocreation process and have an investigation of QoL among users planned as part of pilot testing this app. Future research is warranted to determine the effect of mobile health (mHealth) tools such as smartphone apps among the AYA cancer population. OBJECTIVE The aim of this study was to investigate the feasibility of a smartphone app among AYA patients with cancer in active treatment and posttreatment, in a pilot test by measuring health-related QoL before and after the use of the app. METHODS Participants were recruited via the youth support initiative and social organization for AYAs with cancer, Kræftværket, based at Rigshospitalet, University Hospital of Copenhagen, Denmark. Participants were evenly distributed in active treatment and posttreatment groups. After written informed consent, all participants were asked to use the app Kræftværket as they deemed appropriate over a 6-week period. The participants were asked to complete the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire before and after the 6-week period. The collected QoL data were analyzed with t tests to determine differences between groups and from baseline. RESULTS In total, we enrolled 20 participants, 10 in active treatment and 10 posttreatment (median time after treatment was 4 months) group. Median age of the participants was 25 years. No differences in QoL were seen at baseline (P=.65). The posttreatment group experienced a significant increase in overall QoL after the 6-week period (global QoL: baseline 62.5, SD 22.3; after 6 weeks 80.8, SD 9.7; P=.04). For the group in active treatment, the QoL remained stable throughout the 6 weeks. CONCLUSIONS This study shows the feasibility and possible effect on QoL associated with the use of an mHealth tool in AYA patients. mHealth support tools are warranted for this population.
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Affiliation(s)
- Helle Pappot
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gry Assam Taarnhøj
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Abbey Elsbernd
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Maiken Hjerming
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Hanghøj
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Stark D, Fern LA, Gibson F, Hawkins M, Hough R, McCabe MG, Taylor R. Transitioning adolescent and young adult cancer care research out of its adolescence. Eur J Cancer Care (Engl) 2018; 27:e12962. [DOI: 10.1111/ecc.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Dan Stark
- Department of Cancer Medicine; Leeds UK
- UK NCRI clinical studies group in Teenagers and Young Adults with cancer and Germ Cell Tumours; London UK
| | - Lorna A. Fern
- National Cancer Research Institute Teenage, Young Adult and Germ Cell Clinical Studies Group, Cancer Division; University College London Hospitals NHS Foundation Trust; London UK
| | - Faith Gibson
- Child Health and Cancer Care; Great Ormond Street Hospital for Children NHS Foundation Trust and University of Surrey; London UK
| | - Mike Hawkins
- Centre for Childhood Cancer Survivor Studies; University of Birmingham; Birmingham UK
| | - Rachael Hough
- Haematology and Haemopoietic Stem Cell Transplantation; UCL, London UK
- University College London Hospital’s NHS Foundation Trust; London UK
- NHS England Clinical Reference Group for Children and Young People with Cancer; London UK
| | - Martin G. McCabe
- Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - Rachel Taylor
- Cancer Clinical Trials Unit; CNMR, University College London Hospitals NHS Foundation Trust; London UK
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McDonald FEJ, Patterson P, Kim B, White K. Working beyond the patient and cancer for adolescents and young adults. Eur J Cancer Care (Engl) 2018; 27:e12967. [DOI: 10.1111/ecc.12967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona E. J. McDonald
- CanTeen; Sydney New South Wales Australia
- Cancer Nursing Research Unit; The University of Sydney; Sydney New South Wales Australia
| | - Pandora Patterson
- CanTeen; Sydney New South Wales Australia
- Cancer Nursing Research Unit; The University of Sydney; Sydney New South Wales Australia
| | - Bora Kim
- Cancer Nursing Research Unit; The University of Sydney; Sydney New South Wales Australia
| | - Kathryn White
- Cancer Nursing Research Unit; The University of Sydney; Sydney New South Wales Australia
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