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Becktell K, Chen Y, Yasui Y, Phelan R, Armstrong GT, Link M, Oeffinger K, Snyder C, Daw N, Weil B, Weldon C, Chow EJ, Schwartz CL. Long-term outcomes among survivors of childhood osteosarcoma: A report from the Childhood Cancer Survivor Study (CCSS). Pediatr Blood Cancer 2024; 71:e31189. [PMID: 39010279 PMCID: PMC11343645 DOI: 10.1002/pbc.31189] [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] [Received: 02/26/2024] [Revised: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Treatment strategies for osteosarcoma evolving between 1970 and 1999 improved 5-year survival and continue as standard of care today. This report evaluates the impact of these evolving therapies on long-term health outcomes. METHODS Five-year survivors of childhood osteosarcoma in CCSS treated from 1970 to 1999 were evaluated for late (>5 years from diagnosis) mortality, chronic health conditions (CHCs), and health status using piecewise-exponential and logistical models. Comparisons were made between survivors and siblings without cancer, and among survivors examining historical and current standard chemotherapies (e.g., methotrexate/doxorubicin/cisplatin [MAP] vs. others), specific chemotherapy agents and surgical approaches (amputation vs. limb salvage [LS]). Models were evaluated adjusting for attained age, sex, race, ethnicity, and age at diagnosis. RESULTS A total of 1257 survivors of osteosarcoma were followed on average for 24.4 years. Twenty-year all-cause late mortality was 13.3% (95% confidence interval [CI]: 11.7%-14.9%) overall and 11.7% (95% CI: 6.9%-16.5%) for the subset treated with MAP plus LS. Survivors were at higher risk of CHCs (rate ratio [RR] 3.7, 95% CI: 3.2-4.3) than the sibling cohort, most notably having more serious cardiac, musculoskeletal, and hearing CHCs. Within the survivor cohort, the risk of severe CHCs was twice as high with MAP versus no chemotherapy (RR 2.1, 95% CI: 1.3-3.4). Compared with primary amputation, serious musculoskeletal CHCs were higher after LS (RR 6.6, 95% CI: 3.6-13.4), without discernable differences in health status. CONCLUSION Contemporary osteosarcoma therapy with MAP plus LS, while improving 5-year disease-free survival, continues to be associated with a high burden of late mortality, CHCs, and health status limitations.
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Affiliation(s)
- Kerri Becktell
- Department of Pediatrics, Division of Pediatric Hematology/Oncology/BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Yan Chen
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Rachel Phelan
- Department of Pediatrics, Division of Pediatric Hematology/Oncology/BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Michael Link
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin Oeffinger
- Department of Medicine and Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Claire Snyder
- Departments of Medicine, Oncology, and Health Policy & Management, Johns Hopkins Schools of Medicine and Public Health, Baltimore, Maryland, USA
| | - Najat Daw
- Department of Pediatrics, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brent Weil
- Department of Surgery, Boston Children’s Hospital, Harvard University, Boston, Massachusetts, USA
| | - Christopher Weldon
- Department of Surgery, Boston Children’s Hospital, Harvard University, Boston, Massachusetts, USA
| | - Eric J. Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Cindy L. Schwartz
- Department of Pediatrics, Division of Pediatric Hematology/Oncology/BMT, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Denissen JJ, van der Geest IC, van Hinte G, Desar IM, van der Wees PJ, Koenders N. Explaining needs for rehabilitation in patients with bone sarcoma and a megaprosthesis: a qualitative, grounded theory study. Disabil Rehabil 2024:1-13. [PMID: 39180336 DOI: 10.1080/09638288.2024.2393440] [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: 02/28/2024] [Revised: 08/09/2024] [Accepted: 08/10/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE To explain the needs for rehabilitation of patients with bone sarcoma before and after surgical resection and reconstruction with megaprosthesis. MATERIALS AND METHODS We performed a qualitative study following constructivist grounded theory principles. We purposefully recruited rich cases. Data were collected using semi-structured interviews and analyzed with grounded theory data-analysis. Initial, focused, and theoretical coding were first performed independently by two authors and followed by discussion in consensus meetings with all authors. Ultimately, a conceptual model was created. RESULTS Thirteen participants were interviewed between March and May 2023. Seven theoretical codes were found. The first is the need to achieve a new normal, being able to function with their medical history and megaprosthesis in a new normal life. Two key values patients needed were being understood and being prepared. Four important conditions that patients needed were: optimal conditions for rehabilitation, a trustworthy physical therapist, a clear closure from rehabilitation, and access to expertise in the hospital. The core category was achieving a new normal. CONCLUSIONS Patients with bone sarcoma need rehabilitation to achieve a new normal life. With the understanding of needs regarding rehabilitation now gained, the care for patients with bone sarcoma should be better tailored.
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Affiliation(s)
- Jorinde Jpm Denissen
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Gerben van Hinte
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid Me Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philip J van der Wees
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
- IQ Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
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Anderson AB, Kim E, Park AB, Zhu K, Lin J, Shriver CD, Potter BK. Bone Sarcoma Survival in the US Military Health System: Comparison With the SEER Program. J Am Acad Orthop Surg 2024; 32:e651-e660. [PMID: 38684126 DOI: 10.5435/jaaos-d-23-00897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/25/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Access to care is associated with cancer survival. The US Military Health System (MHS) provides universal health care to all beneficiaries. However, it is unknown whether survival among patients with bone sarcoma in a health system providing universal care is better than that in the general population. The aim of the study was to compare survival of patients with bone sarcoma in the US MHS with that of the US general population. METHODS The MHS data were obtained from the Department of Defense Automated Central Tumor Registry (ACTUR). The US general population data were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. Adult patients were defined as those aged 25 years or older with a histologically confirmed musculoskeletal bone sarcoma diagnosed from January 1, 1987, to December 31, 2013. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to compare the overall survival of the two populations. RESULTS The final analysis included 2,273 bone sarcoma cases from ACTUR and 9,092 bone sarcoma cases from SEER. ACTUR patients had significant lower 5-year all-cause death (hazard ratio = 0.72; 95% CI, 0.66 to 0.78) after adjustment for the potential confounders. ACTUR patients with bone sarcoma also exhibited significantly lower risk of all-cause death during the entire follow-up period than the SEER patients (hazard ratio = 0.75; 95% CI, 0.6 to 0.81). CONCLUSIONS MHS beneficiaries with bone sarcoma may have longer survival than SEER patients. Our findings support the role of universal access to high-quality care in improving bone sarcoma outcomes.
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Affiliation(s)
- Ashley B Anderson
- From the Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD (Anderson, Kim, Zhu, Lin, Shriver, and Potter), Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD (Park, Zhu, and Lin), John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD (Zhu, Lin, and Shriver), and the Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD (Zhu and Lin)
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Suhag A, Sharma KK, Tiwari SK, Joshi P, Rastogi S, Kaur S. Health-related quality of life, psychological issues and concerns among sarcoma survivors: a mixed method study. Ecancermedicalscience 2024; 18:1657. [PMID: 38425760 PMCID: PMC10901627 DOI: 10.3332/ecancer.2024.1657] [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: 10/03/2023] [Indexed: 03/02/2024] Open
Abstract
Purpose We aimed to explore the health-related quality of life (HRQoL), psychological issues and concerns among sarcoma survivors in India and assess their satisfaction with nursing care. Methods This study employed a sequential mixed-methods design, enrolling 100 sarcoma survivors from July to December 2021, with data collected using standardised questionnaires for HRQoL, depression, anxiety, stress, cognitive impairment and self-structured satisfaction with nursing care. Qualitative data were gathered through focused group discussions. Results The mean global health score among sarcoma survivors was 79.48 ± 16.26. A significant number of survivors had symptoms of mild-to-moderate depression (30%), severe anxiety (12%), stress (16%) and mild cognitive impairment (5%). Significant mean rank differences were observed between anxiety and financial difficulty (p < 0.05), emotional functioning (p < 0.001), cognitive functioning (p < 0.001), pain (<0.05), insomnia (p < 0.001), fatigue (p < 0.001), anorexia (p < 0.05) and nausea/vomiting (p < 0.001). Educational qualification had a significant association with depression and anxiety while family history of cancer emerged as a significant factor associated with anxiety and stress among survivors. Qualitative analysis revealed themes related to body image, societal discrimination, socio-economic impact, marriage concerns and fertility issues. Survivor satisfaction with nursing care was good. Conclusion A substantial number of sarcoma survivors had an average HRQoL and experienced depression, anxiety and stress. Our study emphasizes the importance of holistic survivorship care, involving nurses in post-treatment support, and addressing societal discrimination and psychosocial concerns to enhance their quality of life. Implications for cancer survivors Our study calls for a holistic approach to sarcoma survivor care and emphasizes the importance of personalised survivorship care plans led by nurses to address the diverse needs of sarcoma survivors in India. Such plans should encompass strategies for managing depression, anxiety and stress, along with addressing body image concerns and social support.
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Affiliation(s)
- Arti Suhag
- College of Nursing, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Kamlesh Kumari Sharma
- College of Nursing, All India Institute of Medical Sciences, Bathinda, Punjab 151001, India
| | - Surya Kant Tiwari
- College of Nursing, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh 229405, India
- https://orcid.org/0000-0003-4718-0398
| | - Poonam Joshi
- College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal 741250, India
- https://orcid.org/0000-0002-7016-8437
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi 110608, India
| | - Simran Kaur
- Department of Medical Physiology, All India Institute of Medical Sciences, New Delhi 110608, India
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Trost C, Heisinger S, Funovics PT, Windhager R, Hobusch GM, Stamm T. Patients' perception of changes and consequences after tumor resection : A qualitative study in Austrian patients with musculoskeletal malignancies. Wien Klin Wochenschr 2023; 135:301-310. [PMID: 36595059 PMCID: PMC10287576 DOI: 10.1007/s00508-022-02136-6] [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: 05/16/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects and consequences of surgical treatment of patients with musculoskeletal malignancies on everyday life. METHODS A modified form of grounded theory was used for data collection and analysis. Data collection was systematic and analyzed simultaneously and 16 interviews were conducted: 2 narrative, 11 guided and 3 expert interviews (surgeon, physical therapist, support group). Data collection and analysis alternated until no new codes could be found. Once theoretical saturation was achieved, the main category was formed and described using the literature. RESULTS The main category results from the combination of all categories and leads to the core category. In the center is the affected person and in the immediate environment are the patient's relatives/partners. In the next instance the primary care physician is necessary to establish a sense of normalcy. This depends on the individuality of the person and the restored possibilities of movement. CONCLUSION Based on the results, the necessity of implementing psychosocial care involving the social environment is shown. The importance of relatives/partners for recovery is emphasized. Furthermore, the communication between the specialists and family physicians should be simplified.
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Affiliation(s)
- Carmen Trost
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Stephan Heisinger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Philipp T. Funovics
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Gerhard M. Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria
| | - Tanja Stamm
- Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
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Braun I, Friedrich M, Morgenstern L, Sender A, Geue K, Mehnert-Theuerkauf A, Leuteritz K. Changes, challenges and support in work, education and finances of adolescent and young adult (AYA) cancer survivors: A qualitative study. Eur J Oncol Nurs 2023; 64:102329. [PMID: 37172338 DOI: 10.1016/j.ejon.2023.102329] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/14/2023]
Abstract
PURPOSE An increasing number of adolescents and young adults (AYA) are becoming cancer survivors and are dealing with long-term effects of the disease and its treatment. We aimed to collect detailed self-reported information about the areas of work, education, and the financial situation of AYA survivors after acute treatment. We further examined sources of support that were perceived as particular helpful. METHOD We conducted semi-structured interviews with a sample of 11 AYA cancer survivors (on average 5 years from diagnosis; mean age at diagnosis = 25.7 years) that had been recruited for the AYA-Leipzig longitudinal study. Interviews were transcribed and data were analysed using qualitative content analysis. RESULTS The following themes emerged as relevant: (1) career modifications and job loss, (2) career interruptions and delays, (3) uncertainty in the return-to-work process, (4) reduced work ability, (5) discrimination at the workplace, (6) changes in the personal importance of work and (7) financial burdens. Sources of considerable support included relatives as well as German social security institutions. CONCLUSIONS Health care providers should address the specific risk of a financial burden and the somewhat complex social legal situation of young adult survivors after cancer diagnosis. AYA cancer survivors need age-specific comprehensive cancer survivorship support programs. These should accompany them in the long term and be targeted to the individual need for career modification or reorientation - even after the completion of cancer treatment and rehabilitation.
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Affiliation(s)
- Isabella Braun
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Michael Friedrich
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Larissa Morgenstern
- Sachsen-Anhaltische Krebsgesellschaft e.V, Schlossplatz 3, 06844, Dessau, Germany
| | - Annekathrin Sender
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Kristina Geue
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Katja Leuteritz
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
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Hjulstad K, Bondevik H, Hem MH, Nortvedt P. “Struck down by cancer with no old life to fall back on” a clinical study of illness experiences among Norwegian adolescent and young adult cancer survivors investigating the ethical implications of their illness narratives. Cancer Rep (Hoboken) 2022; 6:e1765. [PMID: 36494083 PMCID: PMC10075285 DOI: 10.1002/cnr2.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer is a leading cause of death among people 15-24 years of age. Increasing numbers of cancer patients survive. Extensive cancer therapy may cause wide-ranging somatic and psychosocial challenges in the lives of the survivors. Research indicates adolescent and young adult cancer (AYA) survivors need to be seen as a distinctive group of survivors having unique health care needs. The existing literature suggests the need for specific follow-up care programs addressing the challenges of AYAs and providing them access to specialized after care, as well as a need to explore AYA cancer survivors' own illness experiences. AIMS Through the theoretical lens of narrative medicine and care ethics, our purpose was to investigate the particular challenges encountered by the AYA cancer survivors, and how they view themselves in light of their illness experiences. We ask how AYA cancer survivors are met and understood by their medical professionals? METHODS This study applied a qualitative method using a narrative research design by collecting self-stories of illness in order to conceptualize human experiences of illness among AYA cancer survivors. Eight in-depth interviews were conducted using a narrative analysis according to the narrative plots of restitution, chaos and quest, as suggested by Arthur Frank. RESULTS Hopelessness and a struggle to take part in the activities of daily life as survivors of cancer were revealed. Too ill to fully take part in the society, the AYA cancer survivors strive to be understood for what they are, namely young survivors. CONCLUSION The survivors'stories reveal a moral imperative that needs to be honored by medical professionals in order to improve cancer care. Cancer survivorship may be a lifelong process necessitating long-term follow-up care. With the lack of specific care programs for AYA cancer survivors, follow-up care is provided by general practitioners or other medical professionals, who often lack expertise in the unique challenges faced by AYA survivors. Because they feel their needs are unmet and their stories not understood, the AYA survivors might experience a sense of abandonment. By adopting a care ethics and narrative medicine approach we provide medical professionals a theoretical framework to better understand and care for AYA cancer survivors. Clinical trial number is 2012/1141.
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Affiliation(s)
| | - Hilde Bondevik
- Department of Interdisciplinary Health Sciences University of Oslo Oslo Norway
| | | | - Per Nortvedt
- Centre for Medical Ethics, University of Oslo Oslo Norway
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Olischläger DLT, den Boer LXY, de Heus E, Brom L, Dona DJS, Klümpen HJ, Stapelfeldt CM, Duijts SFA. Rare cancer and return to work: experiences and needs of patients and (health care) professionals. Disabil Rehabil 2022:1-12. [PMID: 35850601 DOI: 10.1080/09638288.2022.2099589] [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: 11/03/2022]
Abstract
PURPOSE Patients with a rare cancer often face delays in their diagnostic and treatment trajectory, which may affect their work. In this study, we explored experiences and needs of: 1) patients with a rare cancer regarding return to work (RTW) and work retention, and 2) (health care) professionals (HCPs) regarding work-related support of patients with a rare cancer, throughout their disease trajectory. METHODS Semi-structured, in-depth interviews with working-age patients with a rare cancer (n = 16), and HCPs (n = 9) were conducted. During the interviews, a predefined topic list was used. Interviews were transcribed verbatim and analysed by means of thematic analysis. RESULTS In total, three themes emerged from the interviews: 1) Awareness in patients and HCPs as a first step towards work, 2) Being/becoming an expert is a tough job, and 3) Enhancing employability through early personalized guidance. CONCLUSIONS Patients with a rare cancer are confronted with uncertainties regarding work, due to an overall lack of knowledge and experience with these types of cancer. Raising awareness among patients, HCPs and employers about rare cancer and its implications, and providing timely individualized, supportive occupational care are required to improve rare cancer patients' ability to work.Implications for rehabilitationRecognizing and paying attention to the work-related consequences of a rare cancer diagnosis and its treatment is essential to facilitate rare cancer patients' occupational rehabilitation process.Multidisciplinary collaboration and involvement of HCPs specialized in rare cancer are required to provide suitable work-related support.A personalized approach is necessary to adequately address rare cancer patients' RTW and work retention needs.
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Affiliation(s)
- Daphne L T Olischläger
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Li Xiang Y den Boer
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Eline de Heus
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Desiree J S Dona
- Department of Human Resources, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, The Netherlands
| | | | - Saskia F A Duijts
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Psychology, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Cancer treatment and Quality of life, Amsterdam, The Netherlands
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9
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Vizer LM, Mikles SP, Piepmeier AT. Cancer-related cognitive impairment in survivors of adolescent and young adult non-central nervous system cancer: A scoping review. Psychooncology 2022; 31:1275-1285. [PMID: 35726379 DOI: 10.1002/pon.5980] [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: 05/28/2021] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Cancer-related cognitive impairments (CRCI) are common after treatment and can have important impacts on the lives of adolescent and young adult (AYA) cancer survivors-those cancer survivors diagnosed between ages 15 and 39. However, most research focuses on survivors diagnosed under age 15 or over age 39 so we know relatively little about CRCI among AYA survivors of non-central nervous system (CNS) cancers. Here we review the research on CRCI among AYA survivors of non-CNS cancers to determine prevalence, associated factors, and impact on survivors' lives as well as implications for future research. METHODS In November 2021 we performed a systematic search of the literature in MEDLINE, Web of Science, PsycInfo, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials to identify peer-reviewed English language articles describing original research with at least one cognitive outcome and conducted with AYA survivors of non-CNS cancer diagnosed as AYAs. We screened 6003 articles and 21 met eligibility criteria. Guided by the PRISMA-ScR Checklist, we extracted study information to meet review objectives. RESULTS Most studies employed cross-sectional surveys or interviews, though some employed longitudinal methods, neurocognitive assessments, or brain imaging. From the subset of articles that reported a prevalence we calculated a weighted mean prevalence of 25.75% and weighted median prevalence of 27.8%. The factors associated with CRCI included female gender, higher dose chemotherapy, and comorbidities. CRCI impacted the lives of AYA survivors through impaired role functioning, financial toxicity, and unmet needs. CONCLUSIONS CRCI is highly prevalent among non-CNS cancer survivors diagnosed as AYAs and impacts quality of life and role functioning. This review suggests a need for further longitudinal, imaging, and mixed methods research and provision of resources to help achieve better quality of life and educational and occupational attainment during what is potentially a decades-long survivorship period. However, although interventions might improve cognition and functioning, the review identified only one pilot study. Digital interventions may be a practical and effective option for this age group, but they have yet to be adequately investigated. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa M Vizer
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sean P Mikles
- Lineberger Comprehensive Cancer Outcomes Program, University of North Carolina, Chapel Hill, NC, USA
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Ingley KM, Maleddu A, Grange FL, Gerrand C, Bleyer A, Yasmin E, Whelan J, Strauss SJ. Current approaches to management of bone sarcoma in adolescent and young adult patients. Pediatr Blood Cancer 2022; 69:e29442. [PMID: 34767314 DOI: 10.1002/pbc.29442] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/02/2021] [Accepted: 10/16/2021] [Indexed: 01/05/2023]
Abstract
Bone tumors are a group of histologically diverse diseases that occur across all ages. Two of the commonest, osteosarcoma (OS) and Ewing sarcoma (ES), are regarded as characteristic adolescent and young adult (AYA) cancers with an incidence peak in AYAs. They are curable for some but associated with unacceptably high rates of treatment failure and morbidity. The introduction of effective new therapeutics for bone sarcomas is slow, and to date, complex biology has been insufficiently characterized to allow more rapid therapeutic exploitation. This review focuses on current standards of care, recent advances that have or may soon change that standard of care and challenges to the expert clinical research community that we suggest must be met.
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Affiliation(s)
- Katrina M Ingley
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Alessandra Maleddu
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Franel Le Grange
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Craig Gerrand
- London Sarcoma Service, Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Archie Bleyer
- Oregon Health and Science University, Portland, Oregon
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospitals NHS Trust, London, UK
| | - Jeremy Whelan
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Sandra J Strauss
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK.,UCL Cancer Institute, London, UK
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11
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Friedman Y. On recovery: re-directing the concept by differentiation of its meanings. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:389-399. [PMID: 33811591 PMCID: PMC8019304 DOI: 10.1007/s11019-021-10014-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
Recovery is a commonly used concept in both professional and everyday contexts. Yet despite its extensive use, it has not drawn much philosophical attention. In this paper, I question the common understanding of recovery, show how the concept is inadequate, and introduce new and much needed terminology. I argue that recovery glosses over important distinctions and even misrepresents the process of moving away from malady as "going back" to a former state of health. It does not invite important nuances needed to distinguish between biomedical, phenomenological, and social perspectives. In addition, I claim that there are many conditions where we are making use of the concept of recovery, although the person recovered from the condition in question, has not regained the same degree of soundness. I show how the concept of recovery leads to conceptual discrepancies that can result in worsening patients' conditions. To gain a fuller understanding, I propose to rethink the direction of the process in question. I define the process of moving away from malady as a move forward towards a new state of soundness. I also suggest three terms, corresponding to different perspectives, to describe this movement forward: 'curing' (biomedical perspective), 'healing' (first-person perspective), and 'habilitating' (social perspective). This new terminology provides a more nuanced understanding of the states of both malady and soundness and an attentiveness as to how they differ and relate.
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Affiliation(s)
- Yael Friedman
- Centre for Philosophy and the Sciences (CPS), Department of Philosophy, Classics, History of Art and Ideas, University of Oslo, Oslo, Norway.
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Exploring Mentorship as a Novel Approach to Improving Quality of Life in Sarcoma Survivors: A Qualitative Pilot Study. Sarcoma 2021; 2021:2042785. [PMID: 34421328 PMCID: PMC8371637 DOI: 10.1155/2021/2042785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
Backgrounds To investigate whether a formal mentoring program involving mentors from the business community could improve the quality of life (QoL) of sarcoma survivors struggling with the late effects of treatment. Methods Seven former sarcoma patients participated in an eight-month formal mentoring program. The program was assessed through a qualitative study involving a phenomenological approach that utilized a hermeneutical design. In-depth, semistructured interviews were conducted with the mentees after the intervention and six months later. The mentors were interviewed after the program was over. The gathered data were interpreted using a thematic analysis. Results The program facilitated dialogue between the mentors and mentees as well as between the mentees. Afterwards, the mentees were more willing to accept the challenges they faced following cancer treatment. During the program, the mentees were pushed out of their comfort zone, which led to mastery and personal growth in them all. However, the program also revealed some additional challenges, including unfulfilled expectations in two mentor-mentee relationships. Conclusions The mentoring program facilitated the mentees' reorientation and enhanced their QoL. Its eight-month duration appeared important in terms of allowing the mentees to go through a long-lasting process with continued support. The program could serve as the basis for larger studies involving other cancer survivors.
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Wayant C, Manquen J, Wendelbo H, Kerr N, Crow M, Goodell J, Tricco AC, Mack JW, Hellman C, Vassar M. Identification of Evidence for Key Positive Psychological Constructs in Pediatric and Adolescent/Young Adult Patients with Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2021; 10:247-259. [PMID: 33464990 PMCID: PMC8220547 DOI: 10.1089/jayao.2020.0184] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Children and adolescents/young adults (AYAs) with cancer are a vulnerable population susceptible to numerous late effects, such as fatigue and depression, which may diminish their long-term psychological, physical, spiritual, and emotional health. A well-rounded understanding of how positive psychological constructs affect the quality of care and treatment outcomes is therefore warranted. Methods: We conducted a scoping review of 15 positive psychological constructs in children and AYAs with cancer. The primary research questions were (1) what is known about positive psychological constructs in children and AYAs with cancer; (2) what value is ascribed to these constructs by patients? Results: Two hundred seventy-six articles were included after database search and screening. These studies were mostly observational or qualitative and conducted in North America. Constructs were often poorly defined, and measurement tools used to gather data were wide ranging. Numerous factors were correlated with increased or decreased expression of certain constructs, but overall themes were difficult to identify. Similarly, patients often spoke of what increased or decreased expression of a construct, with less emphasis on what they implicitly value. Discussion: This scoping review found ample evidence for what increases or decreases expression of positive psychological constructs, but this evidence was observational and often conflicting. In the future, we recommend the development of a core set of psychological outcomes, with definitions and corresponding measurement tools. We further recommend an emphasis on randomized trials to more rigorously study how expression of constructs can be improved and what effect this has on the quality of life.
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Affiliation(s)
- Cole Wayant
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jack Manquen
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Hannah Wendelbo
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Natalie Kerr
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Crow
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jon Goodell
- Department of Library Services, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chan Hellman
- School of Social Work, University of Oklahoma, Norman, Oklahoma, USA
| | - Matt Vassar
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Zambrano SC, Kollár A, Bernhard J. Experiences of return to work after treatment for extremital soft tissue or bone sarcoma: Between distraction and leaving the disease behind. Psychooncology 2020; 29:781-787. [DOI: 10.1002/pon.5349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Sofia C. Zambrano
- University Centre for Palliative Care, InselspitalBern University Hospital Bern Switzerland
| | - Attila Kollár
- Department of Medical Oncology, InselspitalBern University Hospital Bern Switzerland
| | - Jürg Bernhard
- Department of Medical Oncology, InselspitalBern University Hospital Bern Switzerland
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