Predictors of healthy behaviour in long-term survivors of childhood cancer

Preparing for the future: An examination of healthcare provider and patient communication regarding childhood cancer survivorship

BACKGROUND

This qualitative, exploratory study examines the content of communication between healthcare providers (HCP) and childhood cancer patients (CCP) during a medical appointment to evaluate the extent to which cancer survivorship issues (medical and psychosocial) are discussed.

METHODS

The content of the communication for 16 CCP ages 10-22 and their HCP were examined via audio recorded medical appointments occurring within 6 months of the end of active cancer treatment. The data were analysed using template analysis, a constructivist-interpretivist qualitative approach.

RESULTS

HCP addressed more medically focused than psychosocially focused issues related to survivorship.

CONCLUSIONS

Most discussions of survivorship are medically focused, potentially leaving patients with little information about future psychosocial functioning. Recommendations for future research on enhancing discussions about psychosocial issues are presented. This research has the potential to inform future interventions to enhance patient-provider communication on survivorship issues.

Health Promoting Lifestyle Among Israeli Adult Survivors of Childhood Cancer

Background: Childhood cancer survivors are at risk for recurrence of their primary cancer as well as other secondary site cancers. The survivors are also at increased risk for long-term effects such as chronic illnesses. Health promoting lifestyles are therefore especially important for childhood cancer survivors. The purpose of the study was to describe the health promoting behaviors of childhood cancer survivors and to determine whether these behaviors are associated with demographic and clinical characteristics. This is a descriptive-comparative study that took place in an oncology follow-up clinic in Israel. Sample: Seventy-seven childhood cancer survivors. Tools: Health Promoting Lifestyle Profile 2, questionnaire (interpersonal relationships, spiritual growth, physical activity, nutrition, health responsibility, and stress management), and smoking and alcohol consumption and a demographic–clinical questionnaire. The mean item score was moderate-high. Survivors scored highest on interpersonal relationships and spiritual growth while the lowest scoring activities were physical activity and nutrition. About 30% of the survivors abstained from smoking and alcohol consumption. Women, as opposed to men, were more likely to have higher scores related to nutrition and interpersonal relationships while singles as opposed to those who were married were found to have higher scores related to spiritual growth. Conclusions: Health behaviors associated with interpersonal relationships and spiritual growth were more likely to be performed compared to physical activity, good nutrition, and decreased smoking and alcohol consumption. Special attention should be placed on promoting physical activity and good nutrition among survivors of childhood cancer.

Are lifestyle behavioral factors associated with health-related quality of life in long-term survivors of non-Hodgkin lymphoma?

BACKGROUND

The objective of the current study was to determine whether survivors of non-Hodgkin lymphoma are meeting select American Cancer Society (ACS) health-related guidelines for cancer survivors, as well as to examine relationships between these lifestyle factors and health-related quality of life (HRQoL) and posttraumatic stress (PTS).

METHODS

A cross-sectional sample of 566 survivors of NHL was identified from the tumor registries of 2 large academic medical centers. Respondents were surveyed regarding physical activity, fruit and vegetable intake, body weight, tobacco use, HRQoL using the Medical Outcomes Study Short Form-36, and PTS using the Posttraumatic Stress Disorder CheckList-Civilian form. Lifestyle cluster scores were generated based on whether individuals met health guidelines and multiple linear regression analysis was used to evaluate relationships between lifestyle behaviors and HRQoL scores and PTS scores.

RESULTS

Approximately 11% of participants met all 4 ACS health recommendations. Meeting all 4 healthy recommendations was related to better physical and mental QoL (standardized regression coefficient [β], .57 [P<.0001] and β, .47 [P = .002]) and to lower PTS scores (β, -0.41; P = .01).

CONCLUSIONS

Survivors of NHL who met more ACS health-related guidelines appeared to have better HRQoL and less PTS. Unfortunately, many survivors are not meeting these guidelines, which could impact their overall well-being and longevity.

The role of beliefs in the relationship between health problems and posttraumatic stress in adolescent and young adult cancer survivors

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.

A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions

BACKGROUND

Policy and research related to transition to adult care for adolescents and young adults (AYAs) has focused primarily on patient age, disease skills and knowledge.

OBJECTIVE

In an effort to broaden conceptualization of transition and move beyond isolated patient variables, a new social-ecological model of AYA readiness for transition (SMART) was developed.

METHODS

SMART development was informed by related theories, literature, expert opinion and pilot data collection using a questionnaire developed to assess provider report of SMART components with 100 consecutive patients in a childhood cancer survivorship clinic.

RESULTS

The literature, expert opinion and pilot data collection support the relevance of SMART components and a social-ecological conceptualization of transition. Provider report revealed that many components, representing more than age, disease knowledge and skills, related to provider plans for transferring patients.

CONCLUSIONS

SMART consists of inter-related constructs of patients, parents and providers with emphasis on variables amenable to intervention. Results support SMART's broadened conceptualization of transition readiness and need for assessment of multiple stakeholders' perspectives of patient transition readiness. A companion measure of SMART, which will be able to be completed by patients, parents and providers, will be developed to target areas of intervention to facilitate optimal transition readiness. Similar research programmes to establish evidence-based transition measures and interventions are needed.

Development and validation of the health competence beliefs inventory in young adults with and without a history of childhood cancer

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.

The symptom cluster experience profile framework

PURPOSE/OBJECTIVES

To present the novel Symptom Cluster Experience Profile (SCEP) framework for guiding symptom research in adult survivors of childhood cancers and other subgroups at risk for high symptom burden.

DATA SOURCES

Empirically derived model of symptom cluster experience profiles, existing theoretical frameworks, and data-based literature on symptoms and quality of life in adult survivors of childhood cancers.

DATA SYNTHESIS

In a previous study, the authors generated a preliminary model to characterize subgroups of adult survivors of childhood cancers with high-risk symptom cluster profiles. The authors developed the SCEP framework, which depicts symptom cluster experiences as subgroup-specific profiles that are driven by multiple sets of risk and protective factors. The risk and protective factors may directly and indirectly contribute to or alleviate symptoms through their effects on systemic stress. Systemic stress instigates and sustains the symptom experience that, in turn, is expressed through negative diffusion into other components of quality of life, such as functional status, general health perceptions, and overall quality of life.

CONCLUSIONS

The SCEP framework is an initial approach to unbundle the complex heterogeneity that underlies the clustering of symptoms. By measuring a wide range of risk and protective factors in future studies of adult survivors of childhood cancers and other subgroups at risk for high symptom burden, further development and validation of the SCEP framework will occur.

IMPLICATIONS FOR NURSING

The SCEP framework can be used to specify mechanisms underlying symptom cluster profiles and derive interventions targeted to high-risk symptom profiles. Findings from future studies can be translated to risk-based surveillance and symptom management clinical practice guidelines.

Evaluation of a survivorship educational program for adolescent and young adult survivors of childhood cancer

Educational programs to address specific needs of adolescent and young adult (AYA) childhood cancer survivors are scarce. A quarterly speaker series and 1-day conference involved presentations by oncology experts to increase knowledge of AYA cancer survivorship issues and awareness of community programs and resources. Pre- and post-evaluations were administered to determine the program's efficacy. Most rated program satisfaction as "moderately high" to "high" and having met expectations. Self-report ratings indicated a significant increase in perceived knowledge of survivorship topics and resource awareness for AYA childhood cancer survivors and caregivers. Nearly one third attended more than one presentation, indicating that the educational program was beneficial to them. This program was effective in increasing self-reported survivorship education for AYA survivors of childhood cancer, families, and health care providers.