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Ciucci E, Tomberli L, Amore E, Smorti A, Maffei F, Vagnoli L. The Effects of Hospital-Based School Lessons on Children's Emotions, Distress and Pain. CONTINUITY IN EDUCATION 2024; 5:100-110. [PMID: 39036770 PMCID: PMC11259103 DOI: 10.5334/cie.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/01/2024] [Indexed: 07/23/2024]
Abstract
Lessons conducted in hospitals ensure school continuity for hospitalized children unable to attend regular school. Hospital-based school (HS) provides a tailored experience that ensures normality for children through education. The objective of this study is to evaluate the effects of the proposed lessons in reducing negative emotions, distress, and pain in children, as well as fostering positive affects. The study was conducted with 32 hospitalized children, aged 8-12 years, in the Onco-Hematology and Pediatric Unit of Meyer Children's Hospital IRCCS (Florence, Italy). Positive and negative emotions were measured using the Positive and Negative Affect Scale for Children; distress was measured using the Physiological Hyperarousal for Children; pain was measured using the Visual Analogue Scale for children. Variables were assessed before (T0) and after (T1) lessons, for three times; for each variable, collected data were averaged at both T0 and T1. Statistical analyses showed a significant increase in positive emotions in hospitalized children and a significant decrease in negative emotions, distress, and pain; nevertheless, only for pain the significant correlation between its scores before and after the HS lessons indicated that the detected change occurred for all participants in much the same way. These preliminary results suggest that HS lessons can promote hospitalized children's well-being, at least as far as pain reduction is concerned.
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Affiliation(s)
| | | | - Elena Amore
- Meyer Children’s Hospital IRCCS, Florence, Italy
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Offenbacher R, Citron C, Lin J, Hosgood HD, Parsons SK, Moerdler S, Weiser DA. Preventing Infection in Pediatric Patients Receiving Chemotherapy: A Survey of Provider Recommendations. JCO Oncol Pract 2024:OP2300641. [PMID: 38917405 DOI: 10.1200/op.23.00641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/28/2024] [Accepted: 04/02/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE Sepsis is the leading cause of mortality in patients with childhood cancer receiving cytotoxic chemotherapy. Pediatric hematology/oncology and transplant (PHOT) providers must counsel their patients on the safety of public activities and weigh the risk of infection exposure with the social and developmental benefits of in-person school and social outings. We hypothesize that there is significant variability in recommendations given by PHOT providers. METHODS An electronic anonymous survey was developed and piloted by a group of PHOT providers to assess current methods for educating patients and families on limiting infectious exposures. Five clinical vignettes were created by the study team to explore how providers balance the competing priorities of safety and health-related quality of life (HRQoL). The electronic survey was institutional review board-approved and disseminated via email to all PHOT providers affiliated with the Children's Oncology Group across the United States. RESULTS In total, 545 clinicians completed the survey. Most respondents were attending physicians (393, 72%), followed by fellows (61, 11%), advanced practice providers (APPs; 38, 7%), and nurses (37, 7%). On average, nurses and fellows made more conservative recommendations for avoiding infectious exposures compared with the recommendations from attending physicians and APPs (P < .0001). On average, providers with more years of clinical experience expressed less cautious recommendations, whereas those with less years of experience provided more cautious recommendations for avoiding infectious exposures (P = .0072). CONCLUSION This survey demonstrates the importance of collaboration between all members of the care team in defining priorities for balancing safety risk and HRQoL to provide consistent messaging to patients. The variations in survey responses highlight the need for universal guidelines to standardize physician recommendations for limiting infectious exposures in pediatric patients on chemotherapy.
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Affiliation(s)
- Rachel Offenbacher
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
- Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY
| | | | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
| | - Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Daniel A Weiser
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
- Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY
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Arvidsson S, Brobeck E, Nygren JM, Jarfelt M, Aili K, Olsson M. Adult survivors' perceptions of their childhood and the influences of being treated for acute lymphoblastic leukaemia with allogeneic hematopoietic stem cell transplantation as a child: A phenomenographic study. Eur J Oncol Nurs 2024; 70:102592. [PMID: 38669953 DOI: 10.1016/j.ejon.2024.102592] [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: 06/23/2023] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
PURPOSE Adults who had acute lymphoblastic leukaemia (ALL) as children and were treated with allogeneic hematopoietic stem cell transplantation (aHSCT) may have been affected in their lives due to several long-term complications. From a clinical point of view, it is of interest to study how survivors describe their perceptions of their childhood today. The aim was therefore to describe how adults perceived their childhood and the influences of being treated for ALL with aHSCT as a child. METHOD Semi-structured telephone interviews were undertaken with 18 adults who had been treated for childhood ALL with aHSCT and were included in a national cohort of childhood ALL survivors, diagnosed between 1985 and 2007 at an age between 0 and 17 years. A phenomenographic analysis was used. RESULTS Three categories emerged: Feeling different, Feeling security and Feeling guilty. The informants felt that they had been different from other children but had felt security with the healthcare professionals and in care. They felt guilty because both their siblings' and parents' lives had been affected, but at the same time many perceived that they and their family members had become closer to one another. CONCLUSIONS The results emphasised that adults who had been treated for childhood ALL with aHSCT were affected both in negative and positive ways during their childhood. This indicates the importance for early psychosocial care interventions directed to children during their treatment, but also the need for person-centred psychological care in long-term outpatient clinics.
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Affiliation(s)
- Susann Arvidsson
- School of Health and Welfare, Halmstad University, P.O. Box 823, SE-301 18 Halmstad, Sweden.
| | - Elisabeth Brobeck
- Department of Research and Development, Region Halland, Lasarettsvägen, SE-302 33 Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, P.O. Box 823, SE-301 18 Halmstad, Sweden
| | - Marianne Jarfelt
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 426, SE-405 30 Gothenburg, Sweden; The Long-term follow-up for Adult Childhood Cancer Survivors, Oncology Department Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Katarina Aili
- School of Health and Welfare, Halmstad University, P.O. Box 823, SE-301 18 Halmstad, Sweden
| | - Maria Olsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Box 426, SE-405 30 Gothenburg, Sweden; The Long-term follow-up for Adult Childhood Cancer Survivors, Oncology Department Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Larsen MH, Larsen EH, Ålykkja A, Underhaug KA, Ruud E, Lie HC. "The post-it note just said leukemia" - Information exchange challenges of teachers and local stakeholders supporting young childhood cancer survivors at school - A qualitative study from the Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) group. Eur J Oncol Nurs 2024; 68:102464. [PMID: 38029601 DOI: 10.1016/j.ejon.2023.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Explore teachers', school nurses', cancer coordinators' and other local stakeholders' experiences providing education and support for young childhood cancer survivors in the years after treatment. METHODS We conducted four focus groups and three individual telephone interviews with 15 teachers, nine nurses and three other stakeholders, using inductive thematic analysis inspired by Braun & Clark. Nvivo v12 was used for data-management. RESULTS Three main themes were developed; "Perceived parent attitudes and facilitation", "The missing link - lack of communication and collaboration", and "Enabling mastery, inclusion and thriving". Parents were perceived to be the sole managers of providing cancer information and school-related follow-up needs. Teachers and other stakeholders experienced the nonexistence of information from specialist healthcare services and poor communication within the municipality. Teachers went to great lengths to meet survivors' pedagogical needs and facilitate peer interactions. Teachers voiced a need for more cancer and late effect knowledge, not being dependent solely on parents' for information. CONCLUSIONS Teachers and other stakeholders have essential roles in the continuing school experience for survivors. A more regulated teamwork between the stakeholders in the municipalities and the specialist healthcare system could ensure tailored late effect information at school. Implementing formal support could enable a co-creation of a personalized follow up that could relieve the burden on survivors, parents and teachers.
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Affiliation(s)
- Marie H Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1111 Blindern, 0317, Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggt 15, 0458, Oslo, Norway.
| | - Elna H Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1111 Blindern, 0317, Oslo, Norway; Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, P. O. Box 4950 NydalenN-0424, Oslo, Norway.
| | - Anette Ålykkja
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1111 Blindern, 0317, Oslo, Norway; Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, P. O. Box 4950 NydalenN-0424, Oslo, Norway.
| | - Katrine Aass Underhaug
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, P. O. Box 4950 NydalenN-0424, Oslo, Norway.
| | - Ellen Ruud
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, P. O. Box 4950 NydalenN-0424, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, Univerity of Oslo, Postboks 1111 Blindern, 0317, Oslo, Norway.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1111 Blindern, 0317, Oslo, Norway.
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Björklund AC, Darcy L, Santacroce SJ, Granlund M, Björk M. Individual patterns of problems with participation, activity, body function and environment in everyday life for children who completed brain tumor treatment. Disabil Rehabil 2023; 45:3841-3851. [PMID: 36341684 DOI: 10.1080/09638288.2022.2140845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The study purpose was to, with the help of ICF and the CPS model, describe and explain patterns of co-occurring problems with participation in everyday life activities, body functioning and environment for children who completed brain tumor treatment. MATERIALS AND METHODS Hospital, habilitation and school records for nine children (5-11 yrs.) diagnosed with brain tumor, were retrospectively reviewed for everyday problems after treatment completion. These problems were linked to ICF codes. Median code distribution within ICF constructs participation, body function, body structure, activity, and environment were calculated to generate typical (close to median) and atypical (distant from median) patterns of problems on individual and group levels. Two children were in-depth analyzed with collaborative problem-solving (CPS) model to identify participation problems and plausible explanations. RESULTS In total, 4543 ICF linked codes revealed similarities and differences between individuals. The selected child-cases displayed educational challenges and peer-relational problems. The ICF codes related to activity, body function and environment revealed plausible explanations for the children's documented problems with participation in everyday life. CONCLUSIONS The combination of ICF and CPS can provide a comprehensive view of the child's problems and guide development of participation in everyday life-focused interventions for children treated for brain tumors.Implications for rehabilitationCare should be guided by interventions and support directed at individual children and their everyday life.The International Classification of Functioning, Disability and Health (ICF) framework can support identification of the individual child's patterns of problems and how these affects the child's everyday life.It is recommended to start by identifying participation problems when using ICF to identify and describe problems in children's natural settings.The collaborative problem-solving model can guide healthcare, habilitation and school services when identifying and acting on typical and atypical problem patterns experienced by these children.
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Affiliation(s)
- Ann-Christin Björklund
- CHILD research group, SIDR, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Pediatric Hematology and Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Laura Darcy
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Sheila Judge Santacroce
- School of Nursing and Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mats Granlund
- CHILD research group, SIDR, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Mental Health, Norwegian Natural science and Technology Unversity, Trondheim, Norway
| | - Maria Björk
- CHILD research group, SIDR, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Bryl K, Tortora S, Whitley J, Kim SD, Raghunathan NJ, Mao JJ, Chimonas S. Utilization, Delivery, and Outcomes of Dance/Movement Therapy for Pediatric Oncology Patients and their Caregivers: A Retrospective Chart Review. Curr Oncol 2023; 30:6497-6507. [PMID: 37504337 PMCID: PMC10378356 DOI: 10.3390/curroncol30070477] [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: 05/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Children with cancer and their caregivers face physical and psychosocial challenges during and after treatment. Dance/movement therapy (DMT) has been used to improve well-being, promote healthy coping, and mitigate the impact of illness, but limited knowledge exists regarding DMT utilization, delivery, and outcomes in pediatric oncology. This retrospective study aimed to identify reasons for referral to DMT, DMT visit characteristics, key DMT techniques and processes, and clinician-reported outcomes. We examined the electronic medical records of 100 randomly selected pediatric patients (resulting in 1160 visits) who received DMT services between 2011 and 2021. Sociodemographic, clinical, and visit characteristics, referral reasons, and clinician-reported outcomes were reported as frequency and proportions. Qualitative thematic analysis was used to identify key DMT techniques and processes. Among 100 patients (63% female, aged 0-27 years), 77.9% were referred for psychological distress and 19.6% for pain. Two distinct DMT approaches were used during visits: a traditional DMT approach (77%) and a multisensory DMT approach (23%). The most common visit length was 15-25 min (41.6%), followed by sessions of 30-45 min (22.5%) and ≤10 min (18.1%). A total of 61.9% of DMT visits were inpatient and 38.1% outpatient. Of all visits, 8.8% were new and 91.2% were follow-ups. Caregivers were engaged in treatment in 43.7% of visits, and 5.5% of visits focused entirely on the work with the caregiver. DMT intervention focused on self-expression, emotional self-regulation, coping strategies, socialization, and caregiver-child interaction. Clinician-reported outcomes included enhanced coping with hospital experience (58%), improved pain management (27%), improved self-regulation (21%), and increased physical activation (13.2%). The results suggest DMT as a supportive intervention for psychological distress and pain management in pediatric oncology patients and provide insights into DMT practices and outcomes to guide intervention development and future research.
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Affiliation(s)
- Karolina Bryl
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
| | - Suzi Tortora
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
- MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jennifer Whitley
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
- MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Soo-Dam Kim
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
| | - Nirupa J. Raghunathan
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
- Department of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jun J. Mao
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (K.B.)
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Weibel M, Skoubo S, Handberg C, Bertel LB, Steinrud NC, Schmiegelow K, Hallström IK, Larsen HB. Telepresence robots to reduce school absenteeism among children with cancer, neuromuscular diseases, or anxiety—the expectations of children and teachers: A qualitative study in Denmark. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2023. [DOI: 10.1016/j.chbr.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Huang HM, Yeh TC, Liu HC, Lee TY. Parental experiences of educational supports offered during their child's cancer treatment. Child Care Health Dev 2022; 48:486-493. [PMID: 34905229 DOI: 10.1111/cch.12949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To explore how parents of children with cancer offer educational supports during the treatment process. METHODS Based on a descriptive qualitative method design, 29 mothers and 19 fathers of children with cancer were interviewed on their experiences of supporting their child's education during their child's treatment through semi-structured interviews. RESULT Six themes were summarized from the parents' experiences in supporting their child's education during treatment: initial emphasis on survival over education; educational strategies important when returning to everyday life post-treatment; parents and educators have different expectations; child's extracurricular activities provided a sense of accomplishment; preparing for transition to school; and long-term concern was for the child's health and happiness. CONCLUSION Education is part of children's normal development, but education is often placed on hold for a child receiving cancer treatment. Parents of children with cancer are unable to focus on the child's education because of the threat to their child's life. When their child's illness stabilizes, they will begin to utilize their resources to arrange lessons to facilitate returning to school. Through understanding parents' learning expectations, medical professionals can support adjustments to parents' attitudes.
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Affiliation(s)
- Hsiu-Mei Huang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children's Hospital and Mackay Medical College, Taipei, Taiwan
| | - Hsi-Che Liu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children's Hospital and Mackay Medical College, Taipei, Taiwan
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Guleria B, Viswanath S, Soneji D, Kapoor R, Guleria P, Suresh P, Kumar M, Patel A, Swamy S. Cancer in the Adolescent and Young Adults (AYA) and Children: A Comprehensive Analysis of the Epidemiology and Psychosocial Morbidity in the Indian Population. South Asian J Cancer 2021; 11:73-81. [PMID: 35833048 PMCID: PMC9273329 DOI: 10.1055/s-0041-1735482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims
Adolescent and young adults (AYAs), children with cancer, and their guardians have unique psychosocial morbidities adversely effecting quality of life (QOL). This is measurable using patented tools. We analyzed epidemiological and clinicopathological patterns of solid organ cancers in this subgroup. We also assessed psychosocial morbidity and changes in QOL faced by them.
Methods
All patients aged 2 to 39 years, newly diagnosed with cancer from April 2017 to March 2019 were included. Clinical history, diagnosis, staging, treatment, outcomes, and follow-up were recorded. The National Comprehensive Cancer Network (NCCN) distress thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) were used to assess psychosocial morbidity of AYAs, children ≥ 12 years, and parents of children < 12 years. Pediatric Quality of Life Inventory (Peds QL) version 3.0 was used for children < 12 years. Data was analyzed using descriptive statistics.
Results
A total of 571 patients (512 AYAs, 59 children) were enrolled. Median age was 30 years with male predominance (58.1%). Most cases (98.6%) were absent from school or work. Carcinoma breast was the most common in females (29.3%) and non-Hodgkin lymphoma in males (12.6%). 91.06% had overall NCCN distress score ≥ 4. Also, 73.81 and 79.49% had “quite a bit” or “very much” responses on functional and symptom scales, respectively, in EORTC QLQ C-30 questionnaire. Peds QL version 3.0 revealed total score ranging from 276 to 523 for each patient.
Conclusion
AYAs and children with cancer are extremely vulnerable to psychological stress and morbidity. Use of well-established tools help in assessing their mental status and timely psychiatric referral can be initiated.
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Affiliation(s)
- Bhupesh Guleria
- Department of Medical Oncology, Malignant Diseases Treatment Center, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - S. Viswanath
- Department of Medical Oncology, Malignant Diseases Treatment Center, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Dharmesh Soneji
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Rajan Kapoor
- Department of Hematology, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Prerna Guleria
- Department of Pathology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - P. Suresh
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Manish Kumar
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Amol Patel
- Department of Medical Oncology, INHS ASVINI, Mumbai, Maharashtra, India
| | - Shivshankar Swamy
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
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Improving the Quality of Life of Cancer Survivors in School: Consensus Recommendations Using a Delphi Study. CHILDREN 2021; 8:children8111021. [PMID: 34828734 PMCID: PMC8618439 DOI: 10.3390/children8111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/23/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022]
Abstract
Successful school re-entry is important for children following cancer treatment. However, this process is a challenge for teachers. Objectives: To identify (1) the difficulties and needs that teachers have in helping youth cancer survivors be successful in school, (2) the most effective resources that teachers are currently using for helping them, and (3) the ideal contents for a program that could help teachers in this area. Methods: Twenty-eight teachers participated in a Delphi study. Results: A lack of knowledge regarding how to best help and having to deal with the student’s problems were identified as difficulties. Specific training, psychological support, and advice from health professionals were the most commonly reported needs. Maintaining contact with the family and the students and providing personalized attention were viewed as the most useful resources. Finally, knowledge about the disease itself and how to facilitate successful school re-entry were identified as important program components. Conclusion: The findings provide important new information regarding the lack of both resources and support for teachers who seek to help youth cancer survivors. The findings can be used to inform the development of an intervention to help teachers become more successful in facilitating successful school re-entry.
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van Muilekom MM, Luijten MAJ, van Oers HA, Conijn T, Maurice‐Stam H, van Goudoever JB, Grootenhuis MA, Haverman L, M. A. B, J. M. VDB, A. H. M. B, C. C. B, C. J. F, J. W. G, C. M. VDH, B. J, A. K, H. K, B. J. P. K, L. A. M, M. A. MH, M. P, M. A. J. VR, N. W. P. R, H. J. S, A. Y. N. S, F. S, M. M. T, A. S. P. T, F. A. W. Paediatric patients report lower health-related quality of life in daily clinical practice compared to new normative PedsQL TM data. Acta Paediatr 2021; 110:2267-2279. [PMID: 33838052 PMCID: PMC8360011 DOI: 10.1111/apa.15872] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/25/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023]
Abstract
Aim To compare Health‐Related Quality of Life (HRQOL) of paediatric patients with newly collected HRQOL data of the general Dutch population, explore responses to individual items and investigate variables associated with HRQOL. Methods Children (8–12y) and adolescents (13–17y) from the general population (N = 966) and from a paediatric population (N = 1209) completed the Pediatric Quality of Life Inventory (PedsQLTM) online via the KLIK Patient‐Reported Outcome Measures portal. PedsQLTM scale scores were compared between groups with independent t tests, by age group and gender. Responses to PedsQLTM items were explored using descriptive analyses. Linear regression analyses were performed to determine which variables were associated with HRQOL. Results Paediatric patients reported worse HRQOL than the general population on all PedsQLTM scales (p ≤ .001, d = 0.20–1.03), except social functioning, and a high proportion reported problems on PedsQLTM items, for example, ‘I have trouble sleeping’. Younger age, female gender and school absence were negatively associated with HRQOL (β = −0.37–0.10, p ≤ .008). Conclusion Paediatric patients reported lower HRQOL than the general population, and school absence, female gender and younger age were associated with lower HRQOL. The results underline the importance to structurally monitor paediatric patients’ HRQOL in clinical practice to detect problems and offer the right help on time.
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Affiliation(s)
- Maud M. van Muilekom
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | - Michiel A. J. Luijten
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
- Department of Epidemiology and Data Science Amsterdam Public Health Amsterdam UMCVrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Hedy A. van Oers
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | - Thirsa Conijn
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
| | | | - Johannes B. van Goudoever
- Department of Pediatrics Emma Children's HospitalAmsterdam UMCUniversity of AmsterdamVrije Universiteit Amsterdam The Netherlands
| | | | - Lotte Haverman
- Department of Child and Adolescent Psychiatry and Psychosocial Care Amsterdam Reproduction and Development Amsterdam Public Health Emma Children's HospitalAmsterdam UMCUniversity of Amsterdam Amsterdam The Netherlands
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12
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Fotheringham S, Karabon P, Wunderlich-Barillas T, Traynor J, Gowans K. Optimization of School Reintegration for Pediatric Oncology Patients and Their Peers. CONTINUITY IN EDUCATION 2021; 2:60-72. [PMID: 38774892 PMCID: PMC11104304 DOI: 10.5334/cie.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/12/2021] [Indexed: 05/24/2024]
Abstract
Improved survival rates of pediatric oncology patients give them the opportunity to return to school. This can present a significant challenge, as returning students often become vulnerable to peer rejection. The objective of this double-arm descriptive study was to establish a framework from which to optimize a school reintegration intervention for the peers of pediatric oncology patients. Ultimately, the study aimed to promote increased knowledge, acceptance by peers, and a smooth transition back to school for childhood cancer survivors. We utilized age-appropriate surveys to evaluate the knowledge and concerns of 3rd to 8th-grade students in Michigan regarding friends with cancer and to identify concerns of pediatric oncology patients at an academic medical center regarding return to school during or after cancer treatment. The majority of 3rd to 8th-grade students correctly answered questions related to etiology, prognosis, side effects, and treatment of cancer. Respondents in 3rd to 5th grade were significantly more likely than 6th to 8th graders to endorse the perception that cancer is contagious (P = 0.0036). Fewer students who had a friend with cancer were worried that their friend might die, compared to those who did not have a friend with cancer (3rd to 5th graders [P = 0.0002]; 6th to 8th graders [P = < 0.0001]). Results suggest that peer intervention may be optimized via customization based upon student concerns rather than focusing on cancer education. Additionally, personalized interventions and assistance for patients should strive to reduce stigma and differentiation from other students.
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13
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Ballantine K, Gooder C, Ryan E, Macfarlane S. Listening to the experts: Parents' perspectives around infection risk and returning to education and social activities following their child's diagnosis of acute lymphoblastic leukemia. Cancer Rep (Hoboken) 2021; 5:e1424. [PMID: 33988314 PMCID: PMC9199503 DOI: 10.1002/cnr2.1424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 01/30/2023] Open
Abstract
Background During a child's prolonged treatment for acute lymphoblastic leukemia (ALL), there is a need to balance their increased risk of developing infection‐related complications with meeting their educational and social needs. Aims To determine the safe timing of return to social activities for children undergoing treatment for ALL and to determine how parents perceive and act on advice related to infection risk while navigating their child's “return to normal.” Methods and results Medical and educational attendance records were reviewed for 47 children who were diagnosed with ALL and 24 semi‐structured qualitative interviews were conducted with a representative sample of their parents. The majority of children (69%) did not return to education prior to the start of maintenance therapy regardless of the advice that the families received from their healthcare team. Those who returned earlier were at no greater risk of major infection complications (mean = 0.5) than those who did not return until after commencing maintenance (mean = 0.4, P = .74). Parents spoke of the difficulty in obtaining practical, consistent, and timely advice and of balancing infection risk with a desire to return to normalcy. Inconsistent advice and constant vigilance placed a burden on parents which often profoundly affected their mental wellbeing. Overall, parents wanted to make their own decisions about how and when their child returned to education and social activities. They made these decisions based on many factors, of which infection risk was just one. Conclusion Following the study conclusion, a national working group was established—including parent representatives—to implement the study recommendations. This includes the development of a range of practical resources to better support families. Health professional guidelines provide quantitative data pertaining to infection risk, while emphasizing that the returning decisions ultimately rest with the families. This research demonstrates that listening to parents—who are the experts through their lived experiences—is a critical element in creating policies that are responsive, meaningful, and widely accepted.
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Affiliation(s)
- Kirsten Ballantine
- National Child Cancer Network, Auckland, New Zealand.,Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Claire Gooder
- National Child Cancer Network, Auckland, New Zealand.,Child Cancer Foundation, Auckland, New Zealand
| | | | - Scott Macfarlane
- National Child Cancer Network, Auckland, New Zealand.,Starship Blood and Cancer Centre, Starship Child Health, Auckland, New Zealand
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14
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Gilleland Marchak J, Devine KA, Hudson MM, Jacobson LA, Michel G, Peterson SR, Schulte F, Wakefield CE, Sands SA. Systematic Review of Educational Supports of Pediatric Cancer Survivors: Current Approaches and Future Directions. J Clin Oncol 2021; 39:1813-1823. [PMID: 33886350 DOI: 10.1200/jco.20.02471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jordan Gilleland Marchak
- Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
| | - Katie A Devine
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Lisa A Jacobson
- Kennedy Krieger Institute and Johns Hopkins School of Medicine, Baltimore, MD
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
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15
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Stenmarker M, Enskär K, Björk M, Pinkava M, Rolander B, Golsäter M. Childhood Cancer Survivors: Self-Reported Quality of Life during and after the Cancer Trajectory. Asia Pac J Oncol Nurs 2020; 7:336-345. [PMID: 33062828 PMCID: PMC7529025 DOI: 10.4103/apjon.apjon_22_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/21/2020] [Indexed: 11/04/2022] Open
Abstract
Objective This cross-sectional study aimed to present how the unique cancer experience in childhood influences young adults' quality of life (QOL). Methods Qualitative and quantitative methods were used to code and analyze a study-specific questionnaire (133 items). These data are presented in accordance with a conceptual QOL/health-related QOL model. Results The participants included 34 women and 28 men (n = 62) diagnosed with solid tumors/lymphoma in the period 1983-2003, who had been treated at the same childhood cancer center in Sweden. The current mean age was 28.7 years (range: 18-45, standard deviation [SD]: 6.3, median value: 28.5), the mean age at diagnosis was 12.9 years (range: 8-17, SD: 2.3, median value: 13), and the mean time elapsed since treatment was 15.7 years (range: 4-28, SD: 2.4, median value: 15). The response rate was 65%. Higher levels of psychological maturity were reported by women versus men (P = 0.01) and by survivors diagnosed with cancer during adolescence versus school age (P = 0.04). Male participants reported lower levels of physical limitations (P = 0.03) and emotional distress when being of treatment and in contact with health care services (P = 0.04). The strongest factor influencing QOL during therapy was parental support (97%), while the strongest factors after therapy were to live a life similar to peers (82%) and to be satisfied with one's life situation (81%). During treatment, limitations influencing QOL were related to lack of school support (2%), and after treatment, to deteriorated relationships with siblings (5%). Conclusions Life-threatening diseases at young ages have long-term psychosocial effects with ambiguous results at multiple levels. To capture these experiences, we recommend clinical studies that are based on conceptual clarifying frameworks and adopt a quantitative and qualitative research approach.
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Affiliation(s)
- Margaretha Stenmarker
- Department of Pediatrics, Institution for Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Karin Enskär
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Maria Björk
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Mirka Pinkava
- Department of Pediatrics, Södra Älvsborg Hospital, Borås, Sweden
| | - Bo Rolander
- Department of Behavioral Science and Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marie Golsäter
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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16
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Weibel M, Nielsen MKF, Topperzer MK, Hammer NM, Møller SW, Schmiegelow K, Bækgaard Larsen H. Back to school with telepresence robot technology: A qualitative pilot study about how telepresence robots help school-aged children and adolescents with cancer to remain socially and academically connected with their school classes during treatment. Nurs Open 2020; 7:988-997. [PMID: 32587717 PMCID: PMC7308694 DOI: 10.1002/nop2.471] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/23/2019] [Accepted: 02/16/2020] [Indexed: 11/06/2022] Open
Abstract
Aim To explore how an AV1 telepresence robot helps school-aged children and adolescents with cancer to remain socially and academically connected with their school classes during cancer treatment. Design Qualitative pilot study. Methods Data were collected through semi-structured interviews with school-aged children and adolescents (N = 3, 12-14 years) diagnosed with cancer, their parents (N = 3), teachers (N = 2), classmates (12-14 years, N = 15, focus group interviews) and healthcare professionals (N = 4). Participant observation was performed in the child or adolescents' homes and in the classrooms during education participation via an AV1 telepresence robot. Results Five themes emerged: expectations, sociality, learning, spatiality and technology. Participants experienced the robots as facilitating social interaction processes with classmates and inclusion in learning activities, reducing their sense of loneliness and lacking behind educationally. Nevertheless, multiple factors determine whether the robot is perceived as exclusive, including the technical functionality of the robot, spatiality in the classroom and mutual expectations of the parties involved.
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Affiliation(s)
- Mette Weibel
- Pediatric Oncology Research LaboratoryDepartment of Pediatrics and Adolescent MedicineThe Juliane Marie CenterUniversity Hospital (Rigshospitalet)CopenhagenDenmark
- Faculty of Health and Medical ScienceInstitute of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Martin Kaj Fridh Nielsen
- Pediatric Oncology Research LaboratoryDepartment of Pediatrics and Adolescent MedicineThe Juliane Marie CenterUniversity Hospital (Rigshospitalet)CopenhagenDenmark
- Faculty of Health and Medical ScienceInstitute of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Martha Krogh Topperzer
- Pediatric Oncology Research LaboratoryDepartment of Pediatrics and Adolescent MedicineThe Juliane Marie CenterUniversity Hospital (Rigshospitalet)CopenhagenDenmark
- Faculty of Health and Medical ScienceInstitute of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Nanna Maria Hammer
- Pediatric Oncology Research LaboratoryDepartment of Pediatrics and Adolescent MedicineThe Juliane Marie CenterUniversity Hospital (Rigshospitalet)CopenhagenDenmark
- Faculty of Health and Medical ScienceInstitute of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
- Copenhagen Palliative Team for Children and AdolescentsPediatric Oncology ResearchUniversity Hospital (Rigshospitalet)CopenhagenDenmark
| | | | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent MedicineRigshospitalet University HospitalCopenhagenDenmark
- Institute of Clinical MedicineFaculty of MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Hanne Bækgaard Larsen
- Pediatric Oncology Research LaboratoryDepartment of Pediatrics and Adolescent MedicineRigshospitaletUniversity Hospital of CopenhagenCopenhagenDenmark
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17
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Enskär K, Darcy L, Björk M, Knutsson S, Huus K. Experiences of Young Children With Cancer and Their Parents With Nurses' Caring Practices During the Cancer Trajectory. J Pediatr Oncol Nurs 2019; 37:21-34. [PMID: 31526068 DOI: 10.1177/1043454219874007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Children with cancer require repeated hospitalizations and the family's everyday life and routines undergo change. Concrete descriptions of how nurses act when caring for children with cancer throughout the various phases of care and treatment are sparsely highlighted in the literature. The aim of this study was to describe young children with cancer and their parents' experiences of nurses' caring practices over a 3-year period, from diagnosis to follow-up. This study is based on semistructured interviews with 25 children newly diagnosed with cancer, aged 1 to 6 years, and their parents, connected to a pediatric oncology unit in Sweden. Child and parent data were analyzed with a deductive content analysis using Swanson's theory of caring. The result shows that nurse care practices directed toward young children with cancer and their parents are to some extent similar across a 3-year period from diagnosis to follow-up but also differ in some ways. Nurses' caring practices aim to support children and parents in the transition to a "new normal." Child- and family-friendly care processes include the following: creating hope and a trustful relationship, asking rather than assuming, providing knowledge and information, performing tasks skillfully, displaying an interest in the child's and parents' life outside the hospital, and helping the family to trust in the future and other health care providers. Based on these results, we recommend the development of a standardized and structured nursing care plan or clinical guideline with detailed information on how to carry out clinical nurse care practices in the different phases.
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Affiliation(s)
- Karin Enskär
- CHILD Research Group, Jönköping University, Sweden
| | | | - Maria Björk
- CHILD Research Group, Jönköping University, Sweden
| | | | - Karina Huus
- CHILD Research Group, Jönköping University, Sweden
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18
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Medulloblastoma in childhood: What effects on neurocognitive functions? Cancer Radiother 2019; 23:370-377. [DOI: 10.1016/j.canrad.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
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19
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Vanclooster S, Bilsen J, Peremans L, Van Der Werff Ten Bosch J, Laureys G, Paquier P, Jansen A. Reintegration Into School After Treatment for a Brain Tumor: The Child's Perspective. Glob Pediatr Health 2019; 6:2333794X19860659. [PMID: 31321257 PMCID: PMC6610440 DOI: 10.1177/2333794x19860659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 01/18/2023] Open
Abstract
This multiple case study investigated perspectives of childhood brain tumor
survivors on reintegration into school over a 2-year period. Semistructured
interviews were conducted with 5 children at 3 times to obtain an extensive view
of their overall school experience. Thematic analysis of data resulted in 4
themes: “school life and participation,” “peer relations and friendships,”
“performance and difficulties,” and “support and follow-up.” Childhood brain
tumor survivors consider school attendance as part of a normal disease-free
life. Social contact and friendships represent their main motivating factors for
returning to school. Attitudes and feelings regarding performance, difficulties,
and support vary among survivors and change over time. In conclusion, continuity
in learning and social contact established before the return facilitate the
reintegration process. A comprehensive assessment of their academic and
psychosocial functioning should be organized on reentry. Systematic follow-up by
parents, school staff, and health professionals throughout the child’s school
career is required.
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Affiliation(s)
| | | | - Lieve Peremans
- Vrije Universiteit Brussel, Brussels, Belgium.,University of Antwerp, Antwerp, Belgium
| | | | | | - Philippe Paquier
- Vrije Universiteit Brussel, Brussels, Belgium.,Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Jansen
- Vrije Universiteit Brussel, Brussels, Belgium.,UZ Brussel, Brussels, Belgium
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20
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Molcho M, D'Eath M, Alforque Thomas A, Sharp L. Educational attainment of childhood cancer survivors: A systematic review. Cancer Med 2019; 8:3182-3195. [PMID: 31007000 PMCID: PMC6558589 DOI: 10.1002/cam4.2154] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background Advances in treatment mean that most children diagnosed with cancer during childhood survive. Therefore, it is increasingly important to examine the long‐term consequences of childhood cancer, including educational attainment. This systematic review investigated whether the educational attainment of childhood cancer survivors differ from the cancer‐free population. Design/methods We searched seven databases for articles published from January 2005 to August 2018. We identified full papers in English, reporting primary data on academic attainment of adult survivors of childhood cancer, compared to a control group. Quality appraisal was conducted using the Newcastle‐Ottawa Scale. Results Fourteen studies met the inclusion criteria. Nine papers included patients with various types of cancers, four focused on a single type of cancer, and one on patients who underwent stem cell transplantation. Of the 14 papers, 2 studies were considered good quality, 10 were considered adequate quality, and 2 were considered poor quality. Four studies reported more favorable educational attainment among survivors while six did not report significant differences. Less favorable attainment was consistently reported for CNS survivors in four studies. Conclusion The literature does not provide a clear pattern of the long‐term consequences of childhood cancer on education attainment. While this may suggest that there is no consistent difference between the education attainment of cancer survivors and controls, it may also be the result of limitations in the existing research. To better assess the education attainment of survivors, there is a need for high‐quality studies, with appropriate comparators, and standardized measures of education attainment across countries.
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Affiliation(s)
| | | | | | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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21
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Sodergren SC, Husson O, Rohde GE, Tomaszewska IM, Griffiths H, Pessing A, Yarom N, Hooker L, Din A, Darlington AS. Does age matter? A comparison of health-related quality of life issues of adolescents and young adults with cancer. Eur J Cancer Care (Engl) 2019; 27:e12980. [PMID: 30485601 DOI: 10.1111/ecc.12980] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) concerns of adolescents and young adults (AYAs) aged 14-25 years were compared with those of older adults (26-60 years) with cancer. METHODS AYAs and older adults receiving curative intent treatment or supportive palliative care for cancer were recruited from eight research centres across Europe. Participants used a rating scale to score the relevance and importance of a list of 77 issues covering 10 areas of HRQoL concern: symptoms; activity restrictions; social; emotional; body image; self-appraisals; outlook on life; lifestyle; treatment-related and life beyond treatment. RESULTS HRQoL issues were reviewed by 33 AYAs and 25 older adults. Several issues were recognised as relevant and important across all age groups: symptoms, emotional impact, outlook on life, lifestyle and treatment-related. A number of issues were more relevant or important to AYAs including interrupted education, greater motivation to achieve academic goals, increased maturity, boredom, fertility and change in living situation. CONCLUSION While there is overlap in several of the HRQoL concerns across the age span, it is important that HRQoL measures used with AYAs capture the diverse and unique psychosocial aspects of this developmental stage.
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Affiliation(s)
| | | | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.,Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | | | - Aya Pessing
- Department of Oral & Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam Yarom
- Department of Oral Pathology and Oral Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Louise Hooker
- Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Amy Din
- School of Health Sciences, University of Southampton, Southampton, UK
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22
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Beentjes R, Cockett A. Meeting the psychosocial needs of adolescents and their families during a diagnosis of acute lymphoblastic leukaemia. Nurs Child Young People 2019; 31:33-37. [PMID: 31468878 DOI: 10.7748/ncyp.2018.e1033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 06/10/2023]
Abstract
Acute lymphoblastic leukaemia (ALL), an oncological condition affecting blood-producing cells, is the most common type of childhood cancer. It is more common in younger children but the number of young people diagnosed is significant, with about 125 new cases diagnosed each year. While survival rates are high, diagnostic tests, symptoms and treatment regimens can have negative psychological and sociological implications for patients and their families. This article examines the role of the registered children's nurse in meeting the psychosocial needs of adolescents and their families during a diagnosis of ALL. The psychosocial needs considered in this article include those for information, emotional support, collaborative decision-making, education and socialisation. The article also considers physical health needs and financial concerns. The importance of focusing on patients' and families' concerns when arranging psychosocial support is highlighted, together with the requirement to reassess their needs continually throughout the trajectory of the illness.
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Affiliation(s)
| | - Andrea Cockett
- Nursing education, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, England
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23
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Collins DE, Ellis SJ, Janin MM, Wakefield CE, Bussey K, Cohn RJ, Lah S, Fardell JE. A Systematic Review Summarizing the State of Evidence on Bullying in Childhood Cancer Patients/Survivors [Formula: see text]. J Pediatr Oncol Nurs 2018; 36:55-68. [PMID: 30406714 DOI: 10.1177/1043454218810136] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND One in four school-aged children is bullied. However, the risk may be greater for childhood cancer patients/survivors (diagnosed <18 years), because of symptoms of the disease and treatment that may prejudice peers. While the serious consequences of bullying are well documented in the general population, bullying may have even greater impact in children with cancer due to the myriad of challenges associated with treatment and prolonged school absence. OBJECTIVE To summarize the state of evidence on bullying in childhood cancer patients/survivors; specifically, the rate and types of bullying experienced and the associated factors. METHOD We searched five electronic databases from inception to February 2018 for original research articles reporting on bullying in childhood cancer patients/survivors. RESULTS We identified 29 eligible articles, representing 1,078 patients/survivors ( M = 14.35 years). Self-reports from patients/survivors revealed a considerably higher rate of bullying (32.2%) compared with the general population (25%). Our review identified little information on the factors associated with bullying in patients/survivors. However, the bullying described tended to be verbal and was often related to the physical side effects of treatment, indicating that differences in appearance may prejudice peers. It was further suggested that educating the child's classmates about cancer may prevent bullying. CONCLUSIONS Our findings confirm that bullying is a significant challenge for many childhood cancer patients/survivors. Additional studies are needed to identify factors that may influence the risk of bullying, which will inform the development of evidence-based interventions and guidelines to prevent bullying in childhood cancer patients/survivors.
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Affiliation(s)
- Daisy E Collins
- 1 Sydney Children's Hospital, Sydney, New South Wales, Australia.,2 University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah J Ellis
- 1 Sydney Children's Hospital, Sydney, New South Wales, Australia.,2 University of New South Wales, Sydney, New South Wales, Australia
| | - Madeleine M Janin
- 1 Sydney Children's Hospital, Sydney, New South Wales, Australia.,2 University of New South Wales, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- 1 Sydney Children's Hospital, Sydney, New South Wales, Australia.,2 University of New South Wales, Sydney, New South Wales, Australia
| | - Kay Bussey
- 3 Macquarie University, Sydney, New South Wales, Australia
| | - Richard J Cohn
- 1 Sydney Children's Hospital, Sydney, New South Wales, Australia.,2 University of New South Wales, Sydney, New South Wales, Australia
| | - Suncica Lah
- 4 University of Sydney, Sydney, New South Wales, Australia.,5 ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Joanna E Fardell
- 1 Sydney Children's Hospital, Sydney, New South Wales, Australia.,2 University of New South Wales, Sydney, New South Wales, Australia
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24
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Stenmarker E, Mellgren K, Matus M, Schroder Hakansson A, Stenmarker M. Health-related quality of life, culture and communication: a comparative study in children with cancer in Argentina and Sweden. J Patient Rep Outcomes 2018; 2:49. [PMID: 30467612 PMCID: PMC6192945 DOI: 10.1186/s41687-018-0075-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malignant disorders in childhood are life-threatening conditions, and issues regarding the children's health-related quality of life (HRQOL) are crucial in paediatric oncology. The overall aim of this study was to explore HRQOL in children with cancer in two countries, Argentina and Sweden, which have different cultural contexts. The specific aims were: to determine HRQOL by gender, age, diagnosis, treatment modality, time since diagnosis, and parental education/employment across cultures. Further aims were to assess the child/parent relationship in HRQOL and the influence of demographic variables in psychosocial and physical HRQOL in each country. METHODS A cross-sectional study was performed in 2014, including 58 children (24 females, 34 males) and 62 parents/guardians. The instrument, the Pediatric Quality of Life Inventory™ (PedsQL™, generic, cancer and fatigue modules), and medical records were used. The response rate was 97%. RESULTS The mean age of the children was 8.67 years (SD 5.1, range 2-18 years) and the mean time on treatment was 10.7 months (SD 8.7, range 1-30 months). The most common diagnosis was leukaemia (57%). In Argentina, in comparison with Sweden, a higher estimation of generic HRQOL was reported among adolescents (p = 0.022) and more cancer-related problems among school-age children (p < 0.0001). Children and parents in both countries confirmed the major problem with fatigue and multimodality therapy regimes, but lower levels of fatigue were reported in Argentina. Adolescents and children with solid tumours appeared as vulnerable groups. In Sweden, children whose mothers had post-secondary education reported less cancer-related problems (p = 0.031). Good relationships were found between child/parent reports in Argentina regarding the fatigue module (p = 0.034) and physical subscale (p = 0.014), and in Sweden regarding generic health (p = 0.004), including psychosocial (p = 0.006) and physical subscales (p = 0.042), and cancer (p = 0.001), and fatigue (p < 0.0001) modules. In Sweden, psychosocial health (OR 7.5; p = 0.007) and physical health (OR 6.2; p = 0.011) were positively influenced by being a school-age child. CONCLUSIONS Fatigue is as a major problem across cultures. Still, being in school facilitates recovery. Good relationships in psychosocial HRQOL highlight professional challenges regarding severe issues and open communication, and the need of performing comparative studies of HRQOL of children with cancer from different cultural backgrounds.
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Affiliation(s)
- Emelie Stenmarker
- Department of Orthopaedics, Sodra Alvsborg Hospital, Bramhultsvägen 53, SE-501 82, Boras, Sweden
| | - Karin Mellgren
- Department of Paediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 416 85, Gothenburg, Sweden
| | - Mónica Matus
- Instituto de Hematologia y Oncologia del Rosario, San Juan 2395 (2000), Rosario, Pcia Santa Fe, Argentina
| | - Anna Schroder Hakansson
- Department of Paediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 416 85, Gothenburg, Sweden
| | - Margaretha Stenmarker
- Department of Paediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE- 416 85, Gothenburg, Sweden. .,Department of Paediatrics, Futurum - the academy for health and care, Region Jonkoping Council, SE-551 85, Jonkoping, Sweden.
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Coughtrey A, Millington A, Bennett S, Christie D, Hough R, Su MT, Constantinou MP, Shafran R. The Effectiveness of Psychosocial Interventions for Psychological Outcomes in Pediatric Oncology: A Systematic Review. J Pain Symptom Manage 2018; 55:1004-1017. [PMID: 28962919 DOI: 10.1016/j.jpainsymman.2017.09.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT This review summarizes the current randomized controlled trials literature on psychological and physical outcomes of psychosocial interventions in pediatric oncology. OBJECTIVES The objective of this study was to evaluate the effectiveness and impact of psychosocial interventions in children with cancer. METHODS A search of the literature resulted in a total of 12 randomized clinical trials and these have evaluated psychosocial interventions in children younger than 18 years with current and previous diagnoses of cancer. Outcome measures were both psychological (e.g., symptoms of anxiety, depression, quality of life, and self-esteem) and physical (e.g., cancer symptoms, treatment adherence, and pain). Interventions identified included cognitive behavioral therapy (CBT; n = 4), joint CBT and physical exercise therapy (n = 1), family therapy (n = 2), therapeutic music video (n = 2), self-coping strategies (n = 1), a wish fulfillment intervention (n = 1), and joint family therapy and CBT (n = 1). RESULTS Nine studies reported statistically significant improvements on psychological outcomes. These findings suggest that psychosocial interventions are effective at reducing anxiety and depressive symptoms as well as improving quality of life. Additionally, six studies found psychosocial interventions to have a positive impact on physical symptoms and well-being, including a reduction in procedural pain and symptom distress. CONCLUSION These findings suggest that mental health needs in pediatric oncology patients can and should be addressed, potentially which will lead to better mental and physical health outcomes.
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Affiliation(s)
- Anna Coughtrey
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Amy Millington
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Deborah Christie
- Child and Adolescent Psychological Services, University College London Hospital, NHS Foundation Trust, London, UK
| | - Rachael Hough
- Department of Adolescent Haematology, University College London Hospital, NHS Foundation Trust, London, UK
| | - Merina T Su
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK.
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26
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Tsimicalis A, Genest L, Stevens B, Ungar WJ, Barr R. The Impact of a Childhood Cancer Diagnosis on the Children and Siblings’ School Attendance, Performance, and Activities: A Qualitative Descriptive Study. J Pediatr Oncol Nurs 2017; 35:118-131. [DOI: 10.1177/1043454217741875] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Families of children with cancer are confronted with unexpected out-of-pocket expenses and productivity costs associated with the diagnosis. One productivity cost that falls on children is the impact of cancer on children’s school attendance, performance, and activities (eg, play, friendships, and socialization). Nested within the Childhood Cancer Cost Study, this qualitative descriptive study used convenience sampling to recruit and interview parents of children newly diagnosed with cancer. Content analysis techniques were used to inductively descriptive the semistructured interview data. Sixty-six parents of 65 children with cancer and of 73 siblings participated. The most commonly reported productivity loss in children with cancer was school absenteeism mainly due to cancer treatment. Children fell behind their classmates academically and lost important social time with peers. A few siblings also fell behind their peers primarily due to limited parental attention. Parents adopted various strategies to lessen the impact of the diagnosis on their children’s school attendance, performance, and activities. Providing parents with additional resources and support may optimize their children’s academic and social reintegration into school.
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Affiliation(s)
- Argerie Tsimicalis
- McGill University, Montreal, Quebec, Canada
- Shriners Hospitals for Children–Canada, Montreal, Quebec, Canada
| | | | - Bonnie Stevens
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wendy J. Ungar
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ronald Barr
- Pediatric Oncology Group of Ontario (POGO), Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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27
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Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, Dyar R, Darlington AS. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017; 26:1659-1672. [PMID: 28251543 PMCID: PMC5486886 DOI: 10.1007/s11136-017-1520-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
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Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica Robinson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK
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Health-related quality of life in children with surgery for CHD: a study from the Swedish National Registry for Congenital Heart Disease. Cardiol Young 2017; 27:333-343. [PMID: 27225489 DOI: 10.1017/s1047951116000585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND As survival of children with CHD needing surgery has improved significantly, the need for follow-up in terms of health-related quality of life has become increasingly important. In this study, we sought to describe health-related quality of life in children with CHD in relation to cardiac surgery. METHODS A retrospective Swedish National Registry for Congenital Heart Disease survey measured using DISABKIDS chronic generic measure-short version included 337 children (age 9-17 years; 39% girls). The majority (n=319, 95%) of children had a biventricular heart, whereas the remaining had a univentricular heart. Cardiac surgery was performed in 197 (58%) children. Health-related quality of life was expressed as total score (100 highest) and given as medians and 10-90th percentiles. RESULTS The overall total score was 95 (88-100). Children with a biventricular heart who had undergone three or more surgeries (n=31; 9%) had the lowest total score of 81 (61-97; p<0.001). Children with two or more surgeries and those with univentricular heart were classified in NYHA II more frequently than children with one or no cardiac surgery (p=0.005 and <0.001, respectively). Children with three or more surgeries and those with univentricular heart needed more help at school (p<0.001). Compared with children with other chronic diseases, children with CHD had a high total score except for children with three or more surgeries who had comparable total scores with children with other chronic diseases. CONCLUSION Children with three or more cardiac surgeries and those with a univentricular heart appear to have lower health-related quality of life, cognitive ability, and NYHA classification.
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29
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Petersson C, Huus K, Åkesson K, Enskär K. Children's experiences about a structured assessment of health-related quality of life during a patient encounter. Child Care Health Dev 2016; 42:424-32. [PMID: 26888733 DOI: 10.1111/cch.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/04/2015] [Accepted: 01/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been stated that care for children with chronic health conditions tends to focus on condition-specific issues rather than how these children experience their health and everyday life functioning. AIM The aim of this study was to explore children's experiences about a structured assessment of health-related quality of life applied during a patient encounter. METHODS Prior to the start of the study, a clinical intervention based on the questionnaire DISABKIDS Chronic Generic Measure (DCGM-37) was performed. A qualitative explorative design was chosen, and 25 children between 10-17 years of age were interviewed after the consultation at four different paediatric outpatient clinics. Data were analysed according to qualitative content analysis. RESULTS The results were twofold: children experienced that the assessment was providing them with insights about their health, which motivated them to make lifestyle changes. When outcomes were discussed and requested, the children felt encouraged. CONCLUSIONS The use of an assessment of health-related quality of life may promote insights about health and encourage children with chronic health conditions to discuss their outcomes with healthcare professionals.
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Affiliation(s)
- C Petersson
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden
| | - K Huus
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden.,Department of Nursing, School of Health and Welfare, Jönköping University, Sweden
| | - K Åkesson
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden.,The Jönköping Academy for Improvement of Health and welfare, Jönköping University and Futurum, Academy for Health and Care, Jönköping County, Sweden
| | - K Enskär
- Department of Nursing, School of Health and Welfare, Jönköping University, Sweden
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30
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Findlay B, Switzer L, Narayanan U, Chen S, Fehlings D. Investigating the impact of pain, age, Gross Motor Function Classification System, and sex on health-related quality of life in children with cerebral palsy. Dev Med Child Neurol 2016; 58:292-7. [PMID: 26426208 DOI: 10.1111/dmcn.12936] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 11/28/2022]
Abstract
AIM To explore whether health-related quality of life (HRQOL) can be predicted by pain, age, Gross Motor Function Classification System (GMFCS) level, and sex in children with cerebral palsy (CP) and whether different pain etiologies have varying effects on HRQOL. METHODS Children with CP aged 3 to 19 years and their caregivers were consecutively recruited. Caregivers reported their child's pain (Health Utilities Index 3 [HUI3] pain subset) and HRQOL (DISABKIDS questionnaires). Physicians identified pain etiologies. A multiple linear regression model determined whether pain, GMFCS level, sex, and age predicted HRQOL. An ANOVA evaluated the effects of pain etiologies on HRQOL. RESULTS Three hundred and forty-four participants were approached and 87% (n=300) participated. Sufficient data were available on 248 (72% of total sample). Sixty-six participants (27%) formed the pain group with HUI3 pain scores of at least 3. The presence of pain and increasing age significantly negatively predicted HRQOL (p<0.001, R(2) =0.141), while GMFCS and sex did not. Musculoskeletal deformity (24%) and hypertonia (18%) were the most frequent pain causes. HRQOL statistically differed depending on the pain etiology (p=0.028) with musculoskeletal deformity showing the lowest mean HRQOL. INTERPRETATION The presence of pain and increasing age negatively predict HRQOL in CP. musculoskeletal deformity has the greatest negative impact on HRQOL.
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Affiliation(s)
- Briar Findlay
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Bloorview Research Institute, Toronto, ON, Canada
| | | | - Unni Narayanan
- Bloorview Research Institute, Toronto, ON, Canada.,Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shiyi Chen
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Darcy Fehlings
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Bloorview Research Institute, Toronto, ON, Canada
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31
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Einberg EL, Nygren JM, Svedberg P, Enskär K. 'Through my eyes': health-promoting factors described by photographs taken by children with experience of cancer treatment. Child Care Health Dev 2016; 42:76-86. [PMID: 26303054 DOI: 10.1111/cch.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/15/2015] [Accepted: 07/21/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health promotion for children with cancer should be based on the children's own needs and desires. Because there is a lack of knowledge in this area, the aim of this study was to explore what promotes health from the perspective of children with experience of cancer treatment. METHODS Fifteen children between 8 and 12 years of age participated in focus groups with three children in each group. The children were given a camera and instructions to photograph subjects that promote their health. Focus group discussions were based on the photographs and the children's own description of those photographs. The analysis of focus group discussions and photographs was conducted using inductive content analysis. RESULTS According to the children, health-promoting factors are defined as meaningful relationships, recreational activities and a trustful environment. Meaningful relationships include togetherness within the family, affection for pets and friendship with peers. Recreational activities include engagement in play and leisure, withdrawal for relaxation and feeling enjoyment. Trustful environment includes confidence in significant others and feeling safe. CONCLUSIONS Knowledge from this study can contribute to health promotion interventions and quality improvements in the health care of children with experience of cancer treatment. Children's experiences with what promotes health in their everyday lives provide a better understanding of the type of support children prefer when promoting their own health.
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Affiliation(s)
- E-L Einberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.,School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - J M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - P Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - K Enskär
- School of Health Sciences, Jönköping University, Jönköping, Sweden
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32
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Rydström LL, Wiklander M, Navér L, Ygge BM, Eriksson LE. HIV-related stigma and health-related quality of life among children living with HIV in Sweden. AIDS Care 2015; 28:665-71. [PMID: 26679064 DOI: 10.1080/09540121.2015.1120267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The relationship between HIV-related stigma and health-related quality of life (HRQoL) among children living with HIV infection is unknown. The objectives of this study were to describe HIV-related stigma and HRQoL among children with perinatal HIV living in Sweden, and to investigate the relationship between these two factors in the same infection group. In a cross-sectional nationwide survey, HIV-related stigma was measured with the 8-item HIV Stigma Scale for Children. HRQoL was measured with the 37-item DISABKIDS Chronic Generic Module. Structural equation modeling was used to explore the relationship between HIV-related stigma and HRQoL. Fifty-eight children participated, age 9-18 years (mean = 13.9). The HIV stigma general scale showed a mean score of 17.6 (SD = 5.0; possible range 8-32). DISABKIDS Chronic Generic Module general scale showed a mean score of 80.7 (SD = 14.1; possible range 0-100). HIV-related stigma was negatively associated with HRQoL (standardized β = -0.790, p = .017). The results indicate that children's concerns related to disclosure of their HIV infection seem to be common (i.e. 75% agreed) which, together with the negative association between ratings of HIV-relatively stigma and HRQoL, might indicate that disclosure concerns would be a relevant target for interventions to decrease HIV-related stigma and increase HRQoL.
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Affiliation(s)
- Lise-Lott Rydström
- a Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden.,b Karolinska University Hospital, Astrid Lindgren Children's Hospital , Stockholm , Sweden
| | - Maria Wiklander
- a Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden.,c Department of Clinical Sciences , Danderyd Hospital, Karolinska Institutet , Stockholm , Sweden
| | - Lars Navér
- b Karolinska University Hospital, Astrid Lindgren Children's Hospital , Stockholm , Sweden.,e Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden
| | - Britt-Marie Ygge
- b Karolinska University Hospital, Astrid Lindgren Children's Hospital , Stockholm , Sweden.,d Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Lars E Eriksson
- a Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden.,f Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,g Department of Infectious Diseases , Karolinska University Hospital , Huddinge , Sweden.,h School of Health Sciences , City University London , London , UK
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33
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Darcy L, Björk M, Knutsson S, Granlund M, Enskär K. Following Young Children’s Health and Functioning in Everyday Life Through Their Cancer Trajectory. J Pediatr Oncol Nurs 2015; 33:173-89. [DOI: 10.1177/1043454215610489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Knowledge of living with childhood cancer, through the trajectory, is sparse. Aim: The aim of this study was to follow young children’s health and functioning in everyday life through their cancer trajectory. Methods: Data were gathered longitudinally from a group of 13 young children and their parents connected to a pediatric oncology unit in Sweden. The International Classification of Functioning, Disability and Health for Children and Youth structure was used to identify difficulties in health and functioning in everyday life, in interview and questionnaire data. Descriptive statistical analysis was performed to show patterns of difficulty over a 3-year period from diagnosis. Results: Difficulties experienced by children declined and changed over time. An increase in difficulties with personal interactions with others and access to and support from health care professionals was seen 2 to 3 years after diagnosis and start of treatment. Similar patterns are seen within individual children’s trajectories in relation to diagnosis but individual patterns were seen for each child. Conclusions and Clinical Implications: Health care professionals need to plan for ongoing contact with school services and information and support pathways, beyond the treatment period. A person-centered philosophy of care is required throughout the cancer trajectory.
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Affiliation(s)
- Laura Darcy
- Jönköping University, Jönköping, Sweden
- University of Borås, Borås, Sweden
| | - Maria Björk
- Jönköping University, Jönköping, Sweden
- University of Skövde, Skövde, Sweden
| | - Susanne Knutsson
- Jönköping University, Jönköping, Sweden
- University of Borås, Borås, Sweden
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Momani TG, Hathaway DK, Mandrell BN. Factors Affecting Health-Related Quality of Life in Children Undergoing Curative Treatment for Cancer: A Review of the Literature. J Pediatr Oncol Nurs 2015; 33:228-40. [PMID: 26611756 DOI: 10.1177/1043454215609585] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is an important measure to evaluate a child's reported treatment experience. Although there are numerous studies of HRQoL in children undergoing curative cancer treatment, there is limited literature on factors that influence this. OBJECTIVE To review published studies that describe the HRQoL and associated factors in children undergoing curative cancer treatment. METHOD Full-text publications in English from January 2005 to March 2013 were searched in PubMed, PsychINFO, and CINAHL for children ≤18 years of age undergoing curative cancer treatment. HRQoL-associated factors were categorized as cancer diagnosis, treatment, child, family, and community. RESULTS Twenty-six studies met the inclusion criteria. The most frequently used generic and cancer-specific instruments were PedsQL (Pediatric Quality of Life Inventory) Generic and PedsQL Cancer, respectively. Cancer diagnosis and treatment were the most frequently identified variables; fewer studies measured family and community domains. Gender, treatment intensity, type of cancer treatments, time in treatment, and cancer diagnosis were correlated with HRQoL. CONCLUSION Our study highlights the need to develop interventions based on diagnosis and treatment regimen to improve the HRQoL in children undergoing curative cancer treatment.
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Affiliation(s)
- Tha'er G Momani
- St. Jude Children's Research Hospital, Memphis, TN, USA University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Belinda N Mandrell
- St. Jude Children's Research Hospital, Memphis, TN, USA University of Tennessee Health Science Center, Memphis, TN, USA
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35
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Winterling J, Jervaeus A, af Sandeberg M, Johansson E, Wettergren L. Perceptions of School Among Childhood Cancer Survivors. J Pediatr Oncol Nurs 2015; 32:201-8. [DOI: 10.1177/1043454214563405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim was to investigate how childhood cancer survivors perceive school and whether their perceptions differ from corresponding descriptions of peers. Survivors (n = 48) currently attending educational institutions (median 5 years post diagnosis; now aged 12-21 years) from a national cohort of school-age children were compared with matched peers (n = 47). Data were collected through interviews and analyzed qualitatively and quantitatively. The results indicate that survivors and peers perceive school similarly; almost 90% described high well-being in school and indicated that they were motivated and received no additional tutoring; approximately 60% reported no difficulties achieving learning objectives. A few differences were found; survivors described themselves as more satisfied with their academic performance and school environment, but less satisfied with friends, than peers did. Previous treatment with radiation was associated with lower academic satisfaction among survivors. It is suggested that survivors perceive school overall as positive and do not have more problems reaching educational goals than their peers. However, quality of relationships with friends needs further investigation.
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Affiliation(s)
- Jeanette Winterling
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anna Jervaeus
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Margareta af Sandeberg
- Department of Women’s and Children’s Health, Karolinska Institutet, and Department of Pediatric Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Johansson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lena Wettergren
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Huddinge, Sweden
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36
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Castellano-Tejedor C, Pérez-Campdepadrós M, Capdevila L, Blasco-Blasco T. Surviving cancer: The psychosocial outcomes of childhood cancer survivors and its correlates. J Health Psychol 2014; 21:1491-502. [DOI: 10.1177/1359105314557503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study assessed the psychosocial outcomes of adolescent cancer survivors and their relationship with personal and socio-familiar factors. Using a cross-sectional design, 41 survivors answered the four psychosocial dimensions of the KIDSCREEN-52 questionnaire and measures for social support and coping. Similarly, 41 parents answered coping and cancer-related distress measures. All psychosocial scores were within normative values (50 ± 10). Multiple linear regression analyses revealed four models with a range of explained variance between 9.4 percent and 31.9 percent that include the informative and emotional support, parental distress, and coping. This study contributes to the understanding of psychosocial outcomes of childhood cancer survivors and its correlates.
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37
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Einberg EL, Svedberg P, Enskär K, Nygren JM. Friendship Relations From the Perspective of Children With Experience of Cancer Treatment. J Pediatr Oncol Nurs 2014; 32:153-64. [DOI: 10.1177/1043454214554009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Friendships are significant to child development and health but diseases such as cancer can interrupt the contact with friends. The purpose of this study was to describe perceptions of friendship from the perspective of children undergoing cancer treatment, in order to build knowledge that can be used in a health promotion intervention for these children. Fifteen children between 8 and 12 years of age participated in focus groups, where a mixture of informative and creative techniques were used. The focus group discussions were analyzed using qualitative content analysis. The analysis resulted in three generic categories, “Common interests and experiences,” “Mutual empathic actions.” and “Mutual trust and understanding,” incorporating seven subcategories. Based on children’s descriptions from a salutogenic perspective, friendship emerged as An equal and mutual commitment that evolves over time and with interactions face-to-face and digitally, a child perspective on friendship should be central to the development of health promotion interventions designed to support friendship relations of children treated for cancer.
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Affiliation(s)
- Eva-Lena Einberg
- Halmstad University, Halmstad, Sweden
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | | | - Karin Enskär
- School of Health Sciences, Jönköping University, Jönköping, Sweden
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38
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Helms A, Schmiegelow K, Brok J, Johansen C, Thorsteinsson T, Simovska V, Larsen H. Facilitation of school re-entry and peer acceptance of children with cancer: a review and meta-analysis of intervention studies. Eur J Cancer Care (Engl) 2014; 25:170-9. [DOI: 10.1111/ecc.12230] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 12/25/2022]
Affiliation(s)
- A.S. Helms
- Department of Paediatrics and Adolescent Medicine; The University Hospital (Rigshospitalet); Copenhagen Denmark
- The University of Copenhagen; Faculty of Health Science; Copenhagen
| | - K. Schmiegelow
- Department of Paediatrics and Adolescent Medicine; The University Hospital (Rigshospitalet); Copenhagen Denmark
- The University of Copenhagen; Faculty of Health Science; Copenhagen
| | - J. Brok
- Department of Paediatrics and Adolescent Medicine; The University Hospital (Rigshospitalet); Copenhagen Denmark
| | - C. Johansen
- Department of Oncology; Finsen Center; The University Hospital (Rigshospitalet); Copenhagen
- Unit of Survivorship; The Danish Cancer Society, Research Centre; Copenhagen
| | - T. Thorsteinsson
- Department of Paediatrics and Adolescent Medicine; The University Hospital (Rigshospitalet); Copenhagen Denmark
| | - V. Simovska
- Department of Education; Aarhus University, Campus Copenhagen; Copenhagen
| | - H.B. Larsen
- Department of Paediatrics and Adolescent Medicine; The University Hospital (Rigshospitalet); Copenhagen Denmark
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Adolescents' and young adults' experiences of childhood cancer: descriptions of daily life 5 years after diagnosis. Cancer Nurs 2014; 36:400-7. [PMID: 23963195 DOI: 10.1097/ncc.0b013e31829fd80e] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Survivors of childhood cancer are a growing population in society. These young people have a high risk of developing chronic health problems with a potential strong impact on their lives. How a childhood cancer experience affects survivors in adolescence has been studied to a limited extent; an increased understanding of this young group is needed to improve follow-up care. OBJECTIVE The aim of this study was to gain a deeper understanding of how childhood cancer affects the lives of survivors by exploring adolescents' and young adults' views of what it is like living with this experience. METHODS Fifty-nine 11- to 22-year-olds were interviewed a median of 5 years after a cancer diagnosis (response rate, 66%). Data were collected through telephone interviews and were analyzed using qualitative content analysis techniques. RESULTS Three groups of informants were identified according to their descriptions of the influence of cancer treatment on their daily life: "feeling like anyone else" (informants who described that the cancer experience had almost no influence on current life) (49%), "feeling almost like others" (those who described some influence) (44%), and "feeling different" (those describing a great influence on current life) (7%). CONCLUSIONS Most of the adolescents and young adults appear to get along well, although many informants described that life was affected to some extent by having had cancer. IMPLICATIONS FOR PRACTICE Follow-up care is needed that can identify those young survivors of childhood cancer having trouble with daily life and offer them support to strengthen their resources in managing difficulties in relation to having had cancer.
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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Jervaeus A, Lampic C, Johansson E, Malmros J, Wettergren L. Clinical significance in self-rated HRQoL among survivors after childhood cancer - demonstrated by anchor-based thresholds. Acta Oncol 2014; 53:486-92. [PMID: 24160264 DOI: 10.3109/0284186x.2013.844852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a need to establish clinically relevant thresholds (anchors) for identification of differences in health-related quality of life (HRQoL) and thereby provide stronger evidence regarding the HRQoL of childhood cancer survivors. AIM To investigate HRQoL in childhood cancer survivors with a standardised instrument and to establish thresholds for clinically significant differences by using qualitative interviews as anchors. An additional aim was to investigate survivors' HRQoL in relation to an age-matched comparison group without cancer experience. MATERIAL AND METHODS Self-rated HRQoL (KIDSCREEN-27) was assessed in a national cohort of survivors (n = 63, aged 12-22) and a comparison group (n = 257, aged 11-23). Findings from qualitative interview data were also used (n = 61); three subgroups ("Feeling like anyone else"; "Feeling almost like others"; "Feeling different") were identified based on survivors own perception of influence on daily life. Effect size calculations based on means from the KIDSCREEN-27 dimensions were performed using the subgroups as anchors to indicate clinical importance. Furthermore, standard multiple regression analyses were performed. Results. Effect sizes between the subgroups "Feeling like anyone else" and "Feeling almost like others" and the group "Feeling different" were large for all dimensions (1.04-2.07). The multiple regression models showed that being a survivor was significantly associated with one of the dimensions, School Environment, where survivors scored higher HRQoL. Furthermore, female sex and older age (17-23 years) significantly contributed to lower self-rated HRQoL. Conclusion. In clinical practice the KIDSCREEN-27 could be a useful screening tool to identify survivors of childhood cancer in need of extra support, using KIDSCREEN dimension mean values of 45 or less as thresholds. Larger scale studies are recommended to identify and test thresholds with regard to different age groups and time since diagnosis.
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Affiliation(s)
- Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet,
Stockholm, Sweden
| | - Claudia Lampic
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet,
Stockholm, Sweden
| | - Eva Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet,
Stockholm, Sweden
| | - Johan Malmros
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet,
Stockholm, Sweden
- Department of Pediatric Hematology and Oncology, Karolinska University Hospital,
Stockholm, Sweden
| | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet,
Stockholm, Sweden
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Anthony SJ, Selkirk E, Sung L, Klaassen RJ, Dix D, Scheinemann K, Klassen AF. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model. Qual Life Res 2013; 23:771-89. [PMID: 23907613 DOI: 10.1007/s11136-013-0482-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. METHODS A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. RESULTS A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. CONCLUSIONS This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.
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af Sandeberg M, Wettergren L, Björk O, Arvidson J, Johansson E. Does school attendance during initial cancer treatment in childhood increase the risk of infection? Pediatr Blood Cancer 2013; 60:1307-12. [PMID: 23596132 DOI: 10.1002/pbc.24510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 02/04/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study aimed to investigate the relationship between school attendance and infection requiring antimicrobial treatment in children undergoing treatment for cancer. PROCEDURE A national cohort of children aged 7-16 years undergoing cancer treatment was assessed during two observation periods of 19 days each, 1 month (n = 89) and 2.5 months (n = 89) poststart of treatment. Children free from infection at start of each observation period were included. Multivariable logistic regression analyses were performed including factors potentially associated with start of antimicrobial treatment. RESULTS Twenty-seven (30%) children started antimicrobial treatment during the first observation period. Factors associated with an increased risk of starting antimicrobial treatment were diagnosed with sarcoma (OR = 24.37, P = 0.002) or non-Hodgkin lymphoma (OR = 17.57, P = 0.025), having neutropenia (OR = 5.92, P = 0.020) and age less than 13 years (OR = 8.54, P = 0.014). During the second observation period, when 20 (22%) children started antimicrobial treatment, the probability of starting treatment was increased in children with neutropenia (OR = 4.25, P = 0.007). There was no statistically significant association between starting treatment for infection and school attendance. CONCLUSIONS In this study, children attending school while undergoing cancer treatment did not run a higher risk of starting antimicrobial treatment than children absent from school. However, there is a need for further studies evaluating risk of infections in children with ongoing cancer treatment.
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Affiliation(s)
- Margareta af Sandeberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Jervaeus A, Kottorp A, Wettergren L. Psychometric properties of KIDSCREEN-27 among childhood cancer survivors and age matched peers: a Rasch analysis. Health Qual Life Outcomes 2013; 11:96. [PMID: 23764269 PMCID: PMC3693895 DOI: 10.1186/1477-7525-11-96] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 06/10/2013] [Indexed: 02/08/2023] Open
Abstract
Background There is a growing population of children and adolescents that have survived their cancer diagnosis. Therefore, it is of great importance to perform follow-up studies with relevant, valid and sensitive measures. It is of interest both to follow changes over time and to compare results from childhood cancer survivors with those from persons without this experience, to fully understand the impact and complexity of childhood cancer in regard to different aspects of quality of life. The aim of this study was to evaluate the psychometric properties of KIDCSREEN-27 for use with survivors of childhood cancer. Methods KIDSCREEN-27 consists of five dimensions measuring health-related quality of life (HRQoL) in children and adolescents; 63 survivors, (4–6 years post- diagnosis) aged 12–22 and 257 from a comparison group were assessed. KIDSCREEN-27 was evaluated using a Rasch Partial Credit Model (PCM). The aspects studied were the properties of the rating scale including threshold values, internal scale validity, unidimensionality, person response validity, and differential item functioning (DIF) comparing the survivors with peers. Results The rating scales revealed almost expected patterns of responses, and the threshold ordering for two of three rating scales displayed acceptable results. The items demonstrated acceptable goodness-of-fit MnSq values in 23 of 27 items (85.2%). The explained variance within each dimension was above the set criterion (50%) for all dimensions except Autonomy & Parent Relations (39.8%). Person goodness-of-fit showed acceptable results in four of five dimensions. No DIF was detected with regard to cancer experience (survivors/comparison group). Conclusions Based on the performed Rasch analysis, KIDSCREEN-27 is recommended, with the exception of Autonomy & Parent Relations, due to non-satisfactory unidimensionality, for use among adolescents and young adults who have survived childhood cancer. Still, it is recommended that future research should include a larger sample of childhood cancer survivors in order to monitor some items more thoroughly and explore different levels and patterns of HRQoL in KIDSCREEN-27.
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A web-based programme for person-centred learning and support designed for preschool children with long-term illness: a pilot study of a new intervention. Nurs Res Pract 2012; 2012:326506. [PMID: 23326654 PMCID: PMC3544296 DOI: 10.1155/2012/326506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 12/16/2012] [Indexed: 12/30/2022] Open
Abstract
For children living with long-term illness, school age is a risk period with regard to psychosocial ill health and poor compliance with treatment. There is a need for methods to promote health, well-being, and self-esteem. This study describes a new concept for supporting children, person-centred web-based learning and support, which has been tested in 12 preschool children and incorporates learning about feelings, relationships, and the right to integrity. SKYPE was used for conversations between the child and the web teacher. Methods. The programme was developed and tested in two steps. The conversations were tape-recorded and analysed using phenomenography. The questions addressed concerned the quality of the intervention process: accessibility of intervention, learning content and support, and identification of measurable items and patterns. Findings. The children found it interesting to communicate with their web teacher using SKYPE. The story about Max and Sara served as a good basis for discussion, and development was found in the learning process. The children were able to talk about relations and feelings and developed an understanding for use in new situations in their daily lives. Items and patterns that are useful for research and documentation were identified, for example, well-being, resources, needs, and wishes.
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Woolner AF, Davidson A, Skinner R, King D. Evaluation of infection control advice for patients at risk of chemotherapy-induced neutropenia in 2 pediatric oncology centers: Cape Town, South Africa, and Newcastle-Upon-Tyne, UK. Pediatr Hematol Oncol 2012; 29:73-84. [PMID: 22304013 DOI: 10.3109/08880018.2011.642633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Childhood cancers are treated with myelotoxic chemotherapy. Resultant neutropenia can lead to life-threatening infections. There is no consistent guidance on infection control precautions for neutropenic patients who are not yet febrile or infected. Although it is not possible to eradicate infection risk, it is conceivable that the risk could be reduced by effective infection prevention. This study compared infection control measures advised to pediatric and adolescent oncology patients receiving chemotherapy in 2 centers (Cape Town, South Africa, and Newcastle, UK). Prospective, observational, cross-sectional surveys of staff and patients/parents were undertaken using standardized, study-specific questionnaires. Seventy-eight staff and 56 patients/parents participated. Precautions advised in Newcastle were significantly different to Cape Town (all P < .05), except both agreed inpatient isolation was unnecessary. Over 40% of patients/parents felt isolation was important (P < .01). In Cape Town, staff and patients had similar views. In Newcastle, patients/parents had stricter opinions on particular precautions than staff, for example, attending school, playing outside and avoiding busy places (P < .01). Patient/parent responses were similar between centers. Over 90% of staff felt advising patients/parents about hand washing was important. Currently infection prevention advice is inconsistent. Further research is needed to elucidate effective guidance for infection prevention in pediatric neutropenic patients.
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Affiliation(s)
- Andrea Forman Woolner
- School of Medicine and Dentistry, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, UK.
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Klassen AF, Anthony SJ, Khan A, Sung L, Klaassen R. Identifying determinants of quality of life of children with cancer and childhood cancer survivors: a systematic review. Support Care Cancer 2011; 19:1275-87. [PMID: 21611865 DOI: 10.1007/s00520-011-1193-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 05/16/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE This paper describes a systematic review conducted to identify factors that have been investigated as explanations of variability in the quality of life of children with cancer and childhood cancer survivors. Our purpose was to build an evidence base that could be used to guide and direct future research. METHODS MEDLINE, CINAHL, EMBASE, PsycINFO, Cancerlit, and Sociological Abstracts were searched from the inception of each database to June 15, 2009 using the following search terms: "quality of life," "health-related quality of life," "quality adjusted life years," "health status," "functional status," "well-being," or "patient-reported outcome." Sample characteristics and information about the relationship between a quality of life domain or total scale score and at least one factor (e.g., child gender or age, coping skills, family income) were extracted from eligible studies. RESULTS Nine cancer-specific and nine generic QOL questionnaires were used in 58 publications described 239 factors (50 unique factors). The large number of cancer, treatment, child, and family variables considered indicates that extensive research activity has occurred. However, most of the variables identified were examined in only a few studies and most represent medical and treatment variables with less research attention paid to child and family variables. CONCLUSIONS Our study has compiled evidence about determinants of QOL for children with cancer and childhood cancer survivors from the existing literature. Future research can build on this evidence base to expand the range of factors studied as most research to date has focused on medical and treatment factors.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, HSC 3N27, 1200 Main Street West, Hamilton, ON, L8S 4J9, Canada.
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af Sandeberg M, Johansson EM, Hagell P, Wettergren L. Psychometric properties of the DISABKIDS Chronic Generic Module (DCGM-37) when used in children undergoing treatment for cancer. Health Qual Life Outcomes 2010; 8:109. [PMID: 20920171 PMCID: PMC2955689 DOI: 10.1186/1477-7525-8-109] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/28/2010] [Indexed: 11/16/2022] Open
Abstract
Background The aim was to evaluate data quality and psychometric properties of an instrument for measurement of health-related quality of life: DISABKIDS Chronic Generic Module (DCGM-37) used in school-aged children with cancer. Methods All school-children diagnosed with cancer in Sweden during a two-and-a-half year period were invited to participate in the study. Analysis was performed on combined data from two assessments, two and-a-half and five months after start of cancer treatment (n = 170). The instrument was examined with respect to feasibility, data quality, reliability and construct and criterion-based validity. Results Missing items per dimension ranged from 0 to 5.3 percent, with a majority below three percent. Cronbach's alpha values exceeded 0.70 for all dimensions. There was support for the suggested groupings of items into dimensions for all but six of the 36 items of the DCGM-37 included in this study. The instrument discriminated satisfactorily between diagnoses reflecting treatment burden. Conclusions The results indicate satisfactory data quality and reliability of the DCGM-37 when used in children undergoing treatment for cancer. Evaluation of construct validity showed generally acceptable results, although not entirely supporting the suggested dimensionality. Continued psychometric evaluation in a larger sample of children during and after treatment for cancer is recommended.
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Affiliation(s)
- Margareta af Sandeberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
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