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Takenouchi N, Matsuoka M. The Experience of Adolescents and Young Adults in Their Cancer Journeys in Japan: I Try to Move Forward With Feeling That I Would Be Okay With "My Cancer". J Adolesc Young Adult Oncol 2024. [PMID: 39008423 DOI: 10.1089/jayao.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024] Open
Abstract
Purpose: A cancer diagnosis can greatly affect adolescents and young adults (AYAs), especially those in their late teens and early twenties, who might have their special needs. This study aimed to understand the experiences of the AYAs who were diagnosed between 15 and 24 years of age in Japan, thinking about the care guide supporting them, from the time of their cancer diagnosis through the rest of their lives. Methods: Data were collected using semi-structured interviews, which were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts was used to categorize these into themes for comprehensive interpretation. Results: Twenty AYAs participated; they were diagnosed between the ages 15 and 23 and were 19-29 years old at the time of the interview. In total, 14 core categories were identified, consisting of three themes (1) There is a feeling of distance between the cancer and me, (2) I face "my cancer" in my way, and (3) I feel that I would be okay with "my cancer." Conclusions: AYAs had their way of dealing with cancer while experiencing a distant feeling between themselves and the presence of the disease during their cancer journey. Although the process was not simple, they tried to live their lives in their own way, believing that they would be okay. Nurses must respect and understand that AYAs have a process of facing their own cancer with time and watch over AYAs' experiences to appropriately support them to successfully proceed further.
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Affiliation(s)
- Naoko Takenouchi
- University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
- School of Medicine, Faculty of Health Sciences, Kyoto University, Kyoto, Japan
| | - Mari Matsuoka
- School of Nursing, Child Health Nursing, Faculty of Medicine, Mie University Graduate School of Medicine, Mie, Japan
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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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3
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Job MK, Schumacher P, Müller G, Kreyer C. The social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer: A narrative review. Palliat Support Care 2022; 21:1-12. [PMID: 35048846 DOI: 10.1017/s1478951521001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Having a child with cancer is a burdensome experience for parents. Nurses need to better understand beliefs, hopes, and values of parents to holistically support them, which may have an impact on grief and depression. Thus, the aim of this paper was to highlight the social and spiritual dimensions of parental experiences on end-of-life care of their child with cancer. METHOD A narrative literature review was conducted by systematically searching databases (CINAHL Complete, Academic Search Elite, MEDLINE) for relevant literature. The contents of included studies were critically appraised regarding their methodological quality. RESULTS Eleven studies were included. In terms of the social dimension, three categories emerged that are important for parents: Being a Parent, Being in Relationship with the Child, and Being in Relationship with Health Professionals. Parents tried to maintain normality and joy for their child, but also kept control over the situation. They wanted to protect their child from suffering but also felt the need to talk to them about dying. Parents had ambivalent experiences with helpful but also burdensome staff. The spiritual dimension comprised two main categories, Hope and Faith and a Unique Bond. Hope was found to be an important source of strength, while Faith was only mentioned by some parents. For parents the emotional connection with their child constituted a source of meaning as well as a foundation, on which they based their decisions on. SIGNIFICANCE OF RESULTS A therapeutic relationship and a supportive environment can be established by healthcare professionals by noticing, encouraging the unique bond between parents and their children, as well as by reflecting and addressing the parents' challenging situation.
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Affiliation(s)
- Maria Katharina Job
- Hospital of St. John of God in Vienna, Johannes-von-Gott Platz 1, A-1020 Vienna, Austria
| | - Petra Schumacher
- Fachhochschule Krems - University of Applied Sciences Krems, Department of Health Sciences, Institute of Nursing Science, Am Campus Krems, A-3500 Krems, Austria
| | - Gerhard Müller
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
| | - Christiane Kreyer
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Department of Nursing Science and Gerontology, Institute of Nursing Science, Eduard Wallnoefer-Zentrum 1, A-6060 Hall in Tyrol, Austria
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The Psychosocial Interactions of Adolescent and Young Adult Cancer Survivors and the Possible Relationship With Their Development. Cancer Nurs 2021; 44:E23-E33. [PMID: 31356462 DOI: 10.1097/ncc.0000000000000732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs; 16-25 years old) with cancer may be particularly affected by social interactions, as they can be grappling with a serious illness and normal developmental challenges. OBJECTIVES The aims of this study were to explore interactions relevant to AYA survivors and cancer and to investigate whether specific interactions are experienced as more and less helpful. METHODS Ten semistructured interviews were conducted with AYAs, with questions pertaining to their psychosocial interactions and any developmental effects from having cancer. Five follow-up interviews were conducted approximately 12 months later, a 50% response rate. RESULTS Thematic analysis identified a range of themes including the importance of personal privacy and controlled sharing of information, independence, identity formation, positivity, acknowledgement of cancer versus being treated normally, and receiving support instead of supporting others. In the 1-year follow-up interviews, half of these themes remained constant; however, the personal privacy, independence, and supporting others themes changed. CONCLUSIONS Overall, social support, social interactions, and developmental stage seem to influence the overall cancer experience. Development seems to be impacted by cancer for both adolescents and young adults, but this impact lessened over a 1-year period for the 50% of participants who participated in both interviews. IMPLICATIONS FOR PRACTICE It is believed that a more comprehensive understanding of AYA patients' psychosocial experiences related to cancer will enable those who interact with this group to provide more positive support through their interactions with individuals.
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Cuthbert CA, Farragher JF, Farrer CL, Cheung WY. Living with paradox: A qualitative study of colorectal cancer patients' experiences in managing their health after cancer treatment. Eur J Cancer Care (Engl) 2021; 30:e13416. [PMID: 33506569 DOI: 10.1111/ecc.13416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/09/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Managing one's health after colorectal cancer may present specific challenges given long-term impacts to biopsychosocial functioning. Understanding experiences of managing one's health post-treatment is important to informing patient-centred supportive care. METHODS A qualitative study with 19 patients who had completed treatment for colorectal cancer to explore the experience of managing one's health. Following Thorne's Interpretive Description, we conducted interviews using either focus groups or individual interviews. Transcribed data were analysed following Thorne's approach. Sociodemographic and clinical characteristics were also collected. RESULTS The metaphor of living with paradox was the main theme characterising the experiences of managing one's health in the post-treatment period. Participants described the ambiguity of health, their need to accept the new normal, losing control and taking back control, experiencing positive and negative life changes, and the need to continually reframe their perspectives to focus on the positives. CONCLUSION Our findings suggest that providing patient-centred care to colorectal cancer survivors post-treatment involves recognising their changing and sometimes conflicting experiences. Their ability to manage their health may fluctuate and their supportive care needs may not fit with a particular trajectory. Cancer care systems should strive for flexibility in the structure and timing of support available.
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Affiliation(s)
- Colleen A Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Division of Medical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janine F Farragher
- Department of Occupational Science and Occupational Therapy, University of Toronto, Calgary, Alberta, Canada
| | - Christie L Farrer
- Division of Medical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Division of Medical Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,CancerControl, Alberta Health Services, Calgary, Alberta, Canada
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Ingersgaard MV, Fridh MK, Thorsteinsson T, Adamsen L, Schmiegelow K, Baekgaard Larsen H. A qualitative study of adolescent cancer survivors perspectives on social support from healthy peers - A RESPECT study. J Adv Nurs 2021; 77:1911-1920. [PMID: 33470450 DOI: 10.1111/jan.14732] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adolescents' psychosocial development is generally influenced by their peers. Those facing hospital-based cancer treatment are particularly challenged as they are isolated from their social network and lack sufficient coping resources. AIM This study explores the adolescent cancer survivor's perceptions and experiences with healthy classmate socialization support efforts via hospital co-admittance, from diagnosis to reinstatement in school, as an intervention of the RESPECT (REhabilitation including Social and Physical Activity and Education in Children and Teenagers with cancer) Study. DESIGN A phenomenological, descriptive study. METHODS Using variation sampling, 14 adolescents (aged 14-19), who completed the RESPECT intervention (April 2016-July 2017), participated in qualitative, in-depth, semi-structured interviews that were thematically analysed. FINDINGS Four themes emerged: (a) Ambassadors as liaison persons; (b) Ambassadors as promoters of normalization and identity continuity; (c) Ambassadors as 'behind the scenes' friends; and (d) feelings of vulnerability and inferiority. Ambassadors reinstated a sense of normalcy in the adolescents' daily life. They supported identity construction and served as liaison persons who buffered loneliness and social isolation as well as bridging a continued sense of belonging to one's school peer network. In contrast with other peers, ambassadors understood cancer-related issues, knowledge which they partially gained witnessing the impact of treatment-related side effects on their hospitalized classmates. However, the consequence of this trade-off was an asymmetry in their relationship, with the adolescents requiring a certain level of safeguard from their ambassadors to maintain equal power in the relationship. CONCLUSION The ambassadors enhanced the adolescents' ability to cope with their altered social position during treatment and to psychosocially reinstate it on their return to school. IMPACT Future interventions should offer opportunities for healthy peers to be educated in what it means to live with cancer. Future programs to sustain socialization in adolescents with cancer should involve healthy peers for the entirety of the treatment period.
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Affiliation(s)
- Marianne Vie Ingersgaard
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Martin Kaj Fridh
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Troels Thorsteinsson
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Lis Adamsen
- Department of Public Health and Faculty of Health Sciences, The University Hospitals Centre for Nursing and Care Research (UCSF), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Faculty of Health Sciences, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Baekgaard Larsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.,Department of Public Health and Faculty of Health Sciences, The University Hospitals Centre for Nursing and Care Research (UCSF), Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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7
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Sansom‐daly UM, Wakefield CE, Mcgill BC, Patterson P. Ethical and Clinical Challenges Delivering Group‐based Cognitive‐Behavioural Therapy to Adolescents and Young Adults with Cancer Using Videoconferencing Technology. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12112] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ursula M Sansom‐daly
- Kids Cancer Centre, Sydney Children's Hospital,
- School of Women's and Children's Health, University of New South Wales,
- Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital,
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital,
- School of Women's and Children's Health, University of New South Wales,
| | - Brittany C Mcgill
- Kids Cancer Centre, Sydney Children's Hospital,
- School of Women's and Children's Health, University of New South Wales,
| | - Pandora Patterson
- Research, Evaluation and Social Policy, CanTeen Australia,
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney,
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8
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"There Is No Before Cancer… There Is Only Cancer." Perceived Late Effects of Pediatric Cancer on Survivors. Cancer Nurs 2020; 43:468-477. [PMID: 33084294 DOI: 10.1097/ncc.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although "late effects" connotes experiencing effects later in life, they can emerge immediately after active treatment. The effects that survivors experience have been reported but rarely from the point of view of the survivors regarding their life after treatment. OBJECTIVE To examine the perceived late effects of pediatric cancer on survivors and their self-identified primary support persons in order to understand the multifaceted nature of living after a pediatric cancer diagnosis. METHODS Using a pragmatic interpretive phenomenology approach, 10 survivors of pediatric cancer (aged 21-28 years) and 9 of their support persons (aged 23-73 years) participated, completing background questionnaires and semistructured, one-on-one interviews. Interview transcripts were analyzed thematically. RESULTS Both survivors and support persons acknowledged that survivors experienced negative physical and cognitive health outcomes that require follow-up care. Survivors acknowledged that their cancer experience and residual effects have changed the trajectory of their lives. CONCLUSIONS Research on young adult survivors of pediatric cancer and the residual/late effects and emotional outcomes they experience is warranted. Longitudinal research can aid in understanding how effects develop or worsen over time. IMPLICATIONS FOR PRACTICE The findings of this study support The Children's Oncology Group Long-term Follow-up Guidelines for practitioners. As the frontline caring for these individuals and families, nurses' involvement in transitional care out of treatment is necessary. Continued involvement and understanding of long-term pediatric cancer survivorship for nurses are also imperative for continuity for survivors and families.
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Tremolada M, Taverna L, Bonichini S, Pillon M, Biffi A, Putti MC. Pediatric Patients Treated for Leukemia Back to School: A Mixed-Method Analysis of Narratives about Daily Life and Illness Experience. Behav Sci (Basel) 2020; 10:bs10070107. [PMID: 32630265 PMCID: PMC7407376 DOI: 10.3390/bs10070107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022] Open
Abstract
In the last few years, more children and adolescents healed from leukemia go back to their daily life, even if they can show some psycho-social difficulties. The study adopted semi-structured interviews and a mixed-method approach to examine the narratives of 75 children and adolescents about their return to school post 2-years treatment for leukemia. The aims are to collect their illness experiences, to understand how they feel about school and daily routines and to identify the best socio-demographic and illness predictors of a good re-adaptation to school and daily life. The results show that by increasing age and when the pediatric patient have received a hematopoietic stem cell transplantation, at the stop-therapy time, her/his perception about relationships at school and academic performance decrease, especially if his/her feelings about the disease and follow-up visits are negative.
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Affiliation(s)
- Marta Tremolada
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, 8 35131-Padova, Italy;
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy; (M.P.); (A.B.); (M.C.P.)
- Correspondence: ; Tel.: +39-34-7486-8835
| | - Livia Taverna
- Faculty of Education, Free University of Bozen-Bolzano, Brixen-Bressanone, Viale Ratisbona, 16 39042-Bressanone, Italy;
| | - Sabrina Bonichini
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, 8 35131-Padova, Italy;
| | - Marta Pillon
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy; (M.P.); (A.B.); (M.C.P.)
| | - Alessandra Biffi
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy; (M.P.); (A.B.); (M.C.P.)
| | - Maria Caterina Putti
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy; (M.P.); (A.B.); (M.C.P.)
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Vanclooster S, Van Hoeck K, Peremans L, Bilsen J, Van Der Werff Ten Bosch J, Laureys G, Paquier P, Jansen A. Reintegration into school of childhood brain tumor survivors: a qualitative study using the International Classification of Functioning, Disability and Health – Children and Youth framework. Disabil Rehabil 2020; 43:2610-2620. [DOI: 10.1080/09638288.2019.1708484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | | | - Lieve Peremans
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Johan Bilsen
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Geneviève Laureys
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Philippe Paquier
- Center for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anna Jansen
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Pediatric Neurology Unit, UZ Brussel, Brussels, Belgium
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12
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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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Rabelais E, Jones NL, Ulrich CM, Deatrick JA. Meaning Making and Religious Engagement Among Survivors of Childhood Brain Tumors and Their Caregivers. Oncol Nurs Forum 2019; 46:170-184. [PMID: 30767968 DOI: 10.1188/19.onf.170-184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe how adolescent and young adult survivors and their mother-caregivers ascribe meaning to their post-brain tumor survivorship experience, with a focus on sense making and benefit findings and intersections with religious engagement. PARTICIPANTS & SETTING Adolescent and young adult survivors of childhood brain tumors and their families, living in their community settings. METHODOLOGIC APPROACH Secondary analysis of simultaneous and separate individual, semistructured interviews of the 40 matched dyads (80 total interviews) occurred using conventional content analysis across and within dyads. Meaning is interpreted through narrative profiles of expectations for function and independence. FINDINGS Participants made sense of the brain tumor diagnosis by finding benefits and nonbenefits unique to their experiences. Meaning was framed in either nonreligious or religious terms. IMPLICATIONS FOR NURSING Acknowledging positive meaning alongside negative or neutral meaning could enhance interactions with survivors, caregivers, and their families. Exploring the meaning of their experiences may help them to reconstruct meaning and reframe post-tumor realities through being heard and validated.
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Affiliation(s)
| | | | - Connie M Ulrich
- New Courtland Center for Transitions and Health, University of Pennsylvania in Philadelphia
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14
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Easley J. Motivations for cancer history disclosure among young adult cancer survivors. J Cancer Surviv 2019; 13:447-458. [PMID: 31102132 DOI: 10.1007/s11764-019-00766-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To gain an in-depth understanding of the motivations for cancer history disclosure and/or non-disclosure among young adult cancer survivors. METHODS Using a constructivist grounded theory approach, semi-structured telephone interviews were conducted with breast and testicular cancer survivors diagnosed between the ages of 18 and 39 from across Canada. FINDINGS Twenty-eight young adult cancer survivors (16 female; 12 male) participated in this study. Analysis of the interviews revealed two basic motivational systems for disclosure at play: approach-focused motivations geared towards a positive outcome (desire for understanding, acceptance, support and to promote cancer awareness) and avoidance-focused motivations which are geared towards avoiding a negative outcome (fear of discrimination/stigmatization, unwanted attention, pity, loss of privacy, and rejection). Those exhibiting approach-focused motivations were more likely to disclose than those expressing avoidance-focused motivations. Participants also described a series of situational/contextual factors (social/cultural context, relevance, situation/timing, person disclosing, audience/confidant, and time passed since cancer diagnosis) which had the potential to change or influence the disclosure decision despite overarching motivations to disclose or not. IMPLICATIONS FOR CANCER SURVIVORS Gaining a better understanding of the cancer history disclosure decision processes of young adult cancer survivors can help them to better adapt and socially reintegrate back into their pre-cancer lives after the completion of treatment. Acknowledging and understanding the disclosure decision process and communication challenges faced by young cancer survivors can also be beneficial to healthcare professionals in the development and provision of better support interventions and informational resources to help improve psychosocial well-being after cancer.
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Affiliation(s)
- Julie Easley
- Family Medicine Teaching Unit, Dalhousie University, Dr. Everett Chalmers Regional Hospital; 700 Priestman Street, Fredericton, New Brunswick, E3B 5N5, Canada.
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15
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Chan SF, Hoag JA, Karst JS, Bingen KM. Social adjustment of adolescent cancer patients transitioning off active treatment: A short-term prospective mixed methods study. Pediatr Blood Cancer 2019; 66:e27530. [PMID: 30426663 DOI: 10.1002/pbc.27530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/20/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychosocial follow-up in survivorship is a standard of care in pediatric oncology; however, little is known about patients' psychosocial functioning during the transition off active treatment, a unique time in the cancer journey. This study examined the social adjustment of adolescent cancer patients during this transition period, which has been understudied to date. PROCEDURE Participants were 21 patients (ages 12-18 years; age M = 14.71 years; 62% female, 81% White) with various cancer diagnoses. Patients and their parents completed the Social Competence subscale of the Youth Self-Report (YSR) and Child Behavior Checklist (CBCL), respectively, PedsQL Social Functioning subscale, and a semistructured interview 1-2 months prior to ending treatment (time 1) and 3-7 months after ending treatment (time 2). RESULTS YSR and CBCL social competence scores were within the normal range at both time points. PedsQL social functioning scores were more consistent with norms for pediatric cancer samples at time 1 and norms for healthy children at time 2, with self-reported scores significantly improving from time 1 to time 2. A subset of patients had elevated social concerns at time 1, a number that decreased by time 2. Interviews revealed both positive and negative themes related to peer relationships and support, quantity of friends, and socialization. CONCLUSIONS Most adolescent cancer patients are socially well adjusted as they transition off treatment, although a subset have elevated concerns. Interviews provide insight into complex social experiences not captured on questionnaires. Patients may benefit from screening and support during this unique time.
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Affiliation(s)
- Sherilynn F Chan
- Medical College of Wisconsin, Milwaukee, Wisconsin.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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16
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Parents’ Experience of Caring Children with Cancer: A Qualitative Study with Phenomenological Approach. ACTA ACUST UNITED AC 2018. [DOI: 10.5812/compreped.65545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Karst JS, Hoag JA, Chan SF, Schmidt DJ, Anderson LJ, Englebert NE, Igler EC, Bingen KM. Assessment of end-of-treatment transition needs for pediatric cancer and hematopoietic stem cell transplant patients and their families. Pediatr Blood Cancer 2018; 65:e27109. [PMID: 29697192 DOI: 10.1002/pbc.27109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/30/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES The transition off active treatment is a time of significant stress for pediatric cancer patients and families. Providing information and support at this time is among the new psychosocial standards of care in pediatric oncology. This study sought to explore patient and family needs and concerns at the end of their active cancer treatment. DESIGN/METHODS Forty-nine caregiver-child dyads completed semi-structured interviews and surveys 1-2 months before ending treatment, and again 3-7 months after treatment concluded. RESULTS Patients and caregivers reported a moderate level of understanding of follow-up care needs, late effects, and perceived preparation. Altogether, child, adolescent, and young adult cancer patients and parents identified similar priorities for information needed during the transition off active treatment. The most essential pieces of information desired by patients and families across time points included reviews of late effects, schedules for follow-up care, health and physical restrictions, communication with the patient's primary care provider, and provision of a treatment summary. At Time 2, patients and families reported a greater retrospective desire for emotional health resources. Most patients and caregivers wanted information from a variety of sources, but the desired timing to receive this information varied and was dependent on disease group. CONCLUSIONS There are many essential components to end-of-treatment care that are not consistently provided to pediatric cancer patients and families. Formalized programs offering education and support should be provided by multidisciplinary teams prior to the end of active treatment.
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Affiliation(s)
- Jeffrey S Karst
- Medical College of Wisconsin, Department of Pediatrics, Section of Hematology, Oncology, and Blood and Marrow Transplant, Milwaukee, WI.,Children's Hospital of Wisconsin, MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI
| | - Jennifer A Hoag
- Medical College of Wisconsin, Department of Pediatrics, Section of Hematology, Oncology, and Blood and Marrow Transplant, Milwaukee, WI.,Children's Hospital of Wisconsin, MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI
| | - Sherilynn F Chan
- Medical College of Wisconsin, Department of Pediatrics, Section of Hematology, Oncology, and Blood and Marrow Transplant, Milwaukee, WI.,Children's Hospital of Wisconsin, MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI
| | - Debra J Schmidt
- Children's Hospital of Wisconsin, MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI
| | - Lynnette J Anderson
- Medical College of Wisconsin, Department of Pediatrics, Section of Hematology, Oncology, and Blood and Marrow Transplant, Milwaukee, WI.,Children's Hospital of Wisconsin, MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI
| | - Nicole E Englebert
- Children's Hospital and Clinics of Minnesota, Childrens Minnesota Psychological Services, Milwaukee, WI
| | - Eva C Igler
- University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI
| | - Kristin M Bingen
- Medical College of Wisconsin, Department of Pediatrics, Section of Hematology, Oncology, and Blood and Marrow Transplant, Milwaukee, WI.,Children's Hospital of Wisconsin, MACC Fund Center for Cancer and Blood Disorders, Milwaukee, WI
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18
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Abstract
BACKGROUND Despite knowing the potential medical consequences of cancer treatment, little is known about how adolescents cognitively and emotionally frame, process, and manage in the early survivorship period. OBJECTIVE The specific aims were to describe the worries, perceived challenges, and ways of dealing with these issues for adolescent cancer survivors in the early period of survivorship. METHODS Twenty-nine adolescent survivors (12-18 years) completed a semistructured interview. Inductive coding methods adapted from grounded theory were used to analyze the data. RESULTS Seven domains and 18 categories organized the adolescent's experience with early posttreatment survivorship. The domains included getting back to school; relationships with parents, siblings, friends; feeling changed by the experience; and concerns about relapse. CONCLUSIONS This study contributes to our understanding of survivors' relationships with parents, siblings, and friends and survivors' models of the illness. Future studies are needed to understand how parents can help adolescents assume greater responsibility for their care, to understand what it is like for friends to have a peer with cancer and what behaviors by healthcare providers contribute to feelings of abandonment later in survivorship, and to better understand adolescent survivors' models of the illness and survivorship. IMPLICATIONS FOR PRACTICE Study results suggest that nurses are in an ideal position to begin and to continue discussions with adolescent survivors about the adolescent's view of medical follow- up, its purpose and importance, and ways in which the adolescent can begin, early on, to engage in planning their own health during survivorship.
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19
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Howard AF, Kazanjian A, Pritchard S, Olson R, Hasan H, Newton K, Goddard K. Healthcare system barriers to long-term follow-up for adult survivors of childhood cancer in British Columbia, Canada: a qualitative study. J Cancer Surviv 2018; 12:277-290. [PMID: 29222704 PMCID: PMC5956053 DOI: 10.1007/s11764-017-0667-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Risk-stratified life-long follow-up care is recommended for adult childhood cancer survivors (CCS) to ensure appropriate prevention, screening, and management of late effects. The identification of barriers to long-term follow-up (LTFU), particularly in varying healthcare service contexts, is essential to develop and refine services that are responsive to survivor needs. We aimed to explore CCS and healthcare professionals (HCP) perspectives of healthcare system factors that function as barriers to LTFU in British Columbia, Canada. METHODS We analyzed data from 43 in-depth interviews, 30 with CCS and 13 with HCP, using qualitative thematic analysis and constant comparative methods. RESULTS Barriers to accessible, comprehensive, quality LTFU were associated with the following: (1) the difficult and abrupt transition from pediatric to adult health services, (2) inconvenient and under-resourced health services, (3) shifting patient-HCP relationships, (4) family doctor inadequate experience with late effects management, and (5) overdue and insufficient late effects communication with CCS. CONCLUSIONS Structural, informational, and interpersonal/relational healthcare system factors often prevent CCS from initially accessing LTFU after discharge from pediatric oncology programs as well as adversely affecting engagement in ongoing screening, surveillance, and management of late effects. IMPLICATIONS FOR CANCER SURVIVORS Understanding the issues faced by adult CCS will provide insight necessary to developing patient-centered healthcare solutions that are key to accessible, acceptable, appropriate, and effective healthcare.
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Affiliation(s)
- A Fuchsia Howard
- School of Nursing, The University of British Columbia, T201 - 2211 Wesbrook Mall, Vancouver, Canada.
| | - Arminee Kazanjian
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Sheila Pritchard
- Division of Hematology/Oncology, BC Children's Hospital, Vancouver, Canada
| | - Rob Olson
- Department of Surgery, The University of British Columbia, Vancouver, Canada
- Radiation Oncology, BC Cancer Agency - Centre for the North, Prince George, Canada
| | - Haroon Hasan
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, Canada
| | - Kelly Newton
- School of Nursing, The University of British Columbia, T201 - 2211 Wesbrook Mall, Vancouver, Canada
| | - Karen Goddard
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, Canada
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20
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21
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Kim B, Patterson P, White K. Developmental considerations of young people with cancer transitioning to adulthood. Eur J Cancer Care (Engl) 2018. [PMID: 29542833 DOI: 10.1111/ecc.12836] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The literature concerning the impact of having cancer during adolescence and emerging adulthood has been widely discussed in relation to the unique nature of psychosocial challenges. The current study presents these findings within the context of developmental literature to further our understanding on how their developmental transitioning can be affected by having cancer. Specifically, two developmental milestones considered to be the pre-requisites for acquiring an adult status were focused on: forming identity and establishing independence. Several traditions of developmental literature were incorporated, including the psychosocial, sociological and psychoanalytical perspectives. The study discusses challenges to these developmental processes and suggests measures to foster young people's normative development.
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Affiliation(s)
- B Kim
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - P Patterson
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Research & Youth Cancer Services, Research, Evaluation, and Social Policy Unit, CanTeen Australia, Sydney, NSW, Australia
| | - K White
- Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
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22
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Johannsdottir IM, Loge JH, Kiserud CE, Karlstad Ø, Skurtveit S. Increased prescription rates of anxiolytics and hypnotics to survivors of cancer in childhood, adolescence, and young adulthood-A population-based study. Pediatr Blood Cancer 2018; 65. [PMID: 29077266 DOI: 10.1002/pbc.26860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/03/2017] [Accepted: 09/16/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Survivors of cancer diagnosed in childhood, adolescence, or young adulthood (CAYACS) risk psychological morbidities later in life. The study compares prescription rates of anxiolytics and hypnotics among survivors to rates in age- and gender-matched controls. PROCEDURES The population-based cohort included 5,341 cancer survivors, diagnosed ≤25 years of age during 1965-2000. For each survivor, three age- and gender-matched controls were randomly selected from the general population. Data were identified from the Norwegian Cancer and Population registries and linked to the Norwegian Prescription Database. A Cox proportional hazard model was applied to estimate hazard ratios (HRs) of prescriptions during 2004-2012 to the survivors with controls as referents. RESULTS Survivors had an increased risk of being prescribed anxiolytics with crude rates of 16.9/1,000 person years compared to 11.8/1,000 person years in controls (HR 1.41; 95% confidence interval [CI] 1.29-1.54). The relative risk was highest for survivors of neuroblastomas (HR 2.62; 95% CI 1.11-6.16), bone tumors (HR 2.00; 95% CI 1.26-3.18), and central nervous system tumors (HR 1.90; 95% CI 1.40-2.51). The risk of being prescribed hypnotics was increased with crude rates of 20.8/1,000 person years compared to 14.3/1,000 person years in controls (HR 1.44; 95% CI 1.32-1.56). The relative risk was highest for survivors of gastrointestinal tumors (HR 1.80; 95% CI 1.04-3.10), leukemias (HR 1.78; 95% CI 1.32-2.38), and soft tissue cancers (HR 1.70; 95% CI 1.09-2.64). CONCLUSIONS Certain groups of CAYACS have an increased risk for being prescribed anxiolytics or hypnotics compared to controls. Diagnostic reasons for prescriptions are unknown, but the results indicate an increased emotional burden among these groups of survivors.
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Affiliation(s)
- Inga Maria Johannsdottir
- National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway.,Deparment of Pediatric Hematology/Oncology, Oslo University Hospital, Oslo, Norway
| | - Jon H Loge
- Department of Oncology, Regional Advisory Unit for Palliative Care, Oslo University Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Øystein Karlstad
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
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23
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Kim Y. Exploration of life experiences of positive growth in long-term childhood cancer survivors. Eur J Oncol Nurs 2017; 30:60-66. [PMID: 29031315 DOI: 10.1016/j.ejon.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/01/2017] [Accepted: 08/11/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to explore experiences of positive growth in long-term childhood cancer survivors, from their perspective. METHODS Fifteen long-term survivors of childhood cancer provided descriptions of their experiences. Data were collected through face-to-face interviews and the analysis was based on Giorgi's phenomenological research method. RESULTS The analysis of positive growth experienced by long-term childhood cancer survivors revealed three themes: self-directed life, normalcy in life, and inner maturity. Long-term survivors defined positive growth as a successful transition to a self-satisfactory life based on motivation acquired through their cancer experience and on subjective goal-setting, as well as becoming cancer-free and living a normal life within society. They seemed to have acquired optimistic, flexible, active attitudes toward life while demonstrating profound gratefulness and consideration of people around them, as well as prudent approaches to health. CONCLUSIONS The findings of this study verified that long-term survivors of childhood cancer have grown positively due to their negative past experience. We expect these findings to contribute to the development of programs that promote positive growth in long-term childhood cancer survivors.
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Affiliation(s)
- Yoonjung Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
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24
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Molinaro ML, Fletcher PC. “It Changed Everything. And Not All in a Bad Way”: Reflections of Pediatric Cancer Experiences. Compr Child Adolesc Nurs 2017; 40:157-172. [DOI: 10.1080/24694193.2017.1307471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Monica L. Molinaro
- Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Paula C. Fletcher
- Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
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25
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Wong AWK, Chang TT, Christopher K, Lau SCL, Beaupin LK, Love B, Lipsey KL, Feuerstein M. Patterns of unmet needs in adolescent and young adult (AYA) cancer survivors: in their own words. J Cancer Surviv 2017; 11:751-764. [DOI: 10.1007/s11764-017-0613-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
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26
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Scrignaro M, Nichelli F, Cattaneo L, Spinelli M, Magrin ME, Fraschini D, Biondi A, Jankovic M. From Adjustment to Thriving: Exploring Well-Being in Young Adult Survivors of Childhood Cancer and Their Siblings. J Adolesc Young Adult Oncol 2016; 5:330-336. [DOI: 10.1089/jayao.2016.0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marta Scrignaro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Francesca Nichelli
- Psychosocial Service, Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | - Laura Cattaneo
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | - Marco Spinelli
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | | | | | - Andrea Biondi
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
| | - Momcilo Jankovic
- Pediatric Clinic, MBBM Foundation, Maria Letizia Verga Center, Monza, Italy
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27
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Phelps C, Minou M, Baker A, Hughes C, French H, Hawkins W, Leeuwenberg A, Crabtree R, Hutchings PB. Necessary but not sufficient? Engaging young people in the development of an avatar-based online intervention designed to provide psychosocial support to young people affected by their own or a family member's cancer diagnosis. Health Expect 2016; 20:459-470. [PMID: 27292018 PMCID: PMC5433534 DOI: 10.1111/hex.12473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 11/26/2022] Open
Abstract
Objective This study discusses the challenges and successes of engaging young people in a project aimed at developing an online counselling intervention for young people affected by cancer. Context For younger people with a diagnosis of cancer or who are caring for someone with cancer, the psychosocial consequences can create significant challenges for their social and educational development. Whilst young people have been shown to be reluctant to make use of traditional face‐to‐face counselling, research is beginning to suggest that effective therapeutic relationships can be formed with young people online. Design The first phase of the study involved working with a ‘Young Persons’ Panel’ of healthy school pupils and university students to develop and pilot an online counselling intervention and study materials in preparation for a pilot evaluation of the intervention. Intervention An avatar‐based virtual reality counselling world was created where young people can create their own avatar and receive counselling over the Internet from a qualified counsellor via an avatar in a virtual reality world. Findings The process of engaging young people in the C:EVOLVE project enabled a unique intervention to be developed and demonstrated positive developmental opportunities. However, despite the rigorous approach to the development of the intervention, initial attempts within the pilot evaluation phase of the study showed difficulties recruiting to the study, and this phase of the study has currently ceased whilst further exploratory work takes place. Conclusion This study has demonstrated the complexities of intervention development and evaluation research targeted at young people and the challenges created when attempting to bring clinical practice and research evaluation together.
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Affiliation(s)
- Ceri Phelps
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | - Masoumeh Minou
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | - Andrew Baker
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | - Carol Hughes
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | | | - Wayne Hawkins
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | - Andrew Leeuwenberg
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | - Rebecca Crabtree
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
| | - Paul B Hutchings
- School of Psychology, University of Wales Trinity Saint David, Swansea, UK
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28
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Yi J, Kim MA, Sang J. Worries of childhood cancer survivors in young adulthood. Eur J Oncol Nurs 2016; 21:113-9. [DOI: 10.1016/j.ejon.2016.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 12/09/2015] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
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29
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Adult childhood cancer survivors' narratives of managing their health: the unexpected and the unresolved. J Cancer Surviv 2016; 10:711-25. [PMID: 26833205 PMCID: PMC4920835 DOI: 10.1007/s11764-016-0517-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/18/2016] [Indexed: 12/16/2022]
Abstract
Purpose Currently, 80 % of children diagnosed with cancer will be cured. However, many of these survivors go on to develop long-term health problems or late effects related to their previous cancer and therapy and require varying degrees of lifelong follow-up care. The purpose of this study was to identify the different ways that adult survivors of childhood cancer manage their medical and psychological challenges. Methods Data from in-depth interviews with 30 adult survivors of a childhood cancer (9 to 38 years after diagnosis, currently 22 to 43 years of age, 60 % women) were analyzed using qualitative, thematic narrative analysis methods. Results The survivors had not expected the medical, psychological, and social challenges that arose over time and that often remained unresolved. Five narrative themes revealed distinct ways that survivors managed their health challenges: (1) trying to forget cancer, (2) trusting the system to manage my follow-up care, (3) being proactive about my health, (4) stumbling from one problem to the next, and (5) struggling to find my way. Conclusions Variation exists in the ways in which childhood cancer survivors frame their health, their perceived significance of health challenges, strategies used to manage health, interactions with healthcare professionals and the health system, and parental involvement. Implications for Cancer Survivors This research provides novel insights that can be used to inform the development of patient-centered health services that promote the assessment and tailoring of care to the diverse ways survivors enact their agency, as well as their psychoeducational coping styles, therapeutic relationship needs, and information needs.
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30
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Discursive constructions of youth cancer: findings from creative methods research with healthy young people. J Cancer Surviv 2015; 10:427-36. [PMID: 26563950 DOI: 10.1007/s11764-015-0488-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance. METHODS We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer. RESULTS Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to 'cancer victim'. CONCLUSIONS If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer. IMPLICATIONS FOR CANCER SURVIVORS The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer.
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31
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Cantrell M, Conte TM. From Chemo to College: The College Experience of Childhood Cancer Survivors. J Pediatr Oncol Nurs 2015; 33:329-38. [PMID: 26510645 DOI: 10.1177/1043454215604816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this qualitative study was to explore how childhood cancer survivors experience college life. Five undergraduate students who are childhood cancer survivors, aged 19 to 22 years, participated in a 75-minute focus group interview. The survivors attended the same university located in the mid-Atlantic region of the United States. A transcript-based content analysis was used to analyze the data. Four themes and 2 subthemes were generated from the data analysis. Survivors described that the emotional growth they experienced from their cancer experience has provided them some psychological protection in managing the day-to-day challenges of college life and in making informed choices about engaging in high-risk behaviors. As a result of their cancer experience, the findings suggest that these childhood cancer survivors have a strong foundation of self-awareness and self-worth, which has assisted them in making a successful transition into college life and in enjoying positive collegiate experiences.
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32
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Wakefield CE, McLoone JK, Evans NT, Ellis SJ, Cohn RJ. It's more than dollars and cents: the impact of childhood cancer on parents' occupational and financial health. J Psychosoc Oncol 2014; 32:602-21. [PMID: 24988134 DOI: 10.1080/07347332.2014.936653] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Few studies have evaluated the impact of childhood cancer on parents' occupational/financial status. This study explored parents' occupational/financial experiences posttreatment. Semistructured interviews were administered to 78 parents (44 mothers) of childhood cancer survivors diagnosed in the preceding 5 years. Transcripts were organized into themes using QSR NVivo8. Parents reported familial, psychological, and practical factors affecting their ability to return to work. Prioritizing family, reinstigating career progression, and negative workplace attitudes were particularly challenging. Parents of children with cancer experience substantial work-family conflict after their child's physical recovery from cancer. Family friendly policies and further research are recommended.
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Affiliation(s)
- Claire E Wakefield
- a School of Women's and Children's Health, UNSW Medicine , University of New South Wales , Kensington , NSW , Australia
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33
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Poplack DG, Fordis M, Landier W, Bhatia S, Hudson MM, Horowitz ME. Childhood cancer survivor care: development of the Passport for Care. Nat Rev Clin Oncol 2014; 11:740-50. [PMID: 25348788 DOI: 10.1038/nrclinonc.2014.175] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Survivors of childhood cancer are at risk of long-term adverse effects and late effects of the disease and/or its treatment. In response to national recommendations to improve evidence-based follow-up care, a web-based support system for clinical decision making, the Passport for Care (PFC), was developed for use at the point of care to produce screening recommendations individualized to the survivor. To date, the PFC has been implemented in over half of the nearly 200 clinics affiliated with the Children's Oncology Group across the USA. Most clinician users report that the PFC has been integrated into clinic workflows, and that it fosters improved conversations with survivors about the potential late effects a survivor might experience and about the screening and/or behavioural interventions recommended to improve health status. Furthermore, clinicians using the PFC have indicated that they adhered more closely to follow-up care guidelines. Perspectives on the challenges encountered and lessons learned during the development and deployment of the PFC are reviewed and contrasted with other nationwide approaches to the provision of guidance on survivor follow-up care; furthermore, the implications for the care of childhood cancer survivors are discussed.
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Affiliation(s)
- David G Poplack
- Hematology-Oncology Section, Department of Paediatrics, Texas Children's Cancer Center, Baylor College, One Baylor Plaza, Houston, TX 77030, USA
| | - Michael Fordis
- Center for Collaborative and Interactive Technologies, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Wendy Landier
- Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Melissa M Hudson
- Cancer Survivorship Division, Departments of Oncology and Epidemiology, and Cancer Control, St Jude's Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Marc E Horowitz
- Hematology-Oncology Section, Department of Paediatrics, Texas Children's Cancer Center, Baylor College, One Baylor Plaza, Houston, TX 77030, USA
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34
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Lopez AD, Bradley-Klug KL, Quinn GP, Reitsema LJ, Ruble K, Slifer KJ. Adolescent Survivors of Childhood Cancer and Their Perspectives of the Transition to Early Survivorship: An Exploratory Qualitative Investigation. J Adolesc Young Adult Oncol 2014. [DOI: 10.1089/jayao.2014.0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Kathy Ruble
- Johns Hopkins University, Baltimore, Maryland
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35
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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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Rabin C, Simpson N, Morrow K, Pinto B. Intervention format and delivery preferences among young adult cancer survivors. Int J Behav Med 2014; 20:304-10. [PMID: 22328444 DOI: 10.1007/s12529-012-9227-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Young adult cancer survivors face a number of increased medical and psychosocial risks, including an increased risk of cardiovascular disease and emotional distress. Although behavioral strategies, such as exercise, may diminish some of these risks, few behavioral interventions have been developed for this population. PURPOSE As a first step toward developing interventions specifically for young survivors, we conducted a qualitative study of their intervention-related preferences. A key objective was to identify the preferred format for delivering interventions (e.g., face-to-face, online). METHOD In-depth, semi-structured individual interviews were conducted with 20 young adult cancer survivors between the ages of 18 and 39. This research was conducted in Rhode Island, USA. RESULTS Participants identified advantages and disadvantages to a variety of intervention formats including: telephone-based, print-based, computer-based, and several types of face-to-face interventions. The dominant theme that emerged was that interventions developed for young adult cancer survivors should take into account their multiple competing needs and obligations (e.g., work, family). Two closely related subthemes were: (1) the importance of developing interventions that are convenient and (2) the need for interventions that provide social support. Interventions for this population may be most successful if they take into account these themes. CONCLUSION Data indicate that young adult cancer survivors have some unique needs (e.g., multiple competing demands of young adulthood) and preferences (e.g., comfort with remotely delivered interventions) that differentiate them from older cancer survivors. Thus, young survivors would be best served by interventions designed to specifically target this population.
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Affiliation(s)
- Carolyn Rabin
- Centers for Behavioral and Preventive Medicine, Miriam Hospital and Alpert Medical School, Brown University, Providence, RI, USA.
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Lewis P, Jordens CFC, Mooney-Somers J, Smith K, Kerridge I. Growing Up With Cancer. J Pediatr Oncol Nurs 2013; 30:311-9. [DOI: 10.1177/1043454213513839] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adolescence and young adulthood are transitional periods of rapid and dramatic personal change. Few events can cause as unpredictable and challenging alterations to this process as the onset of a serious illness, such as cancer. Although we know much about the physical and psychological consequences of having cancer at this time, we know little about the effect of cancer on young people’s relationships. We conducted interviews with 15 women and 12 men aged between 16 and 29 years, who had survived cancer. Our findings demonstrate that the experience of cancer and how it affects relationships is complex. It arrests young people’s development by increasing their dependence on parents, giving them life experiences unavailable to peers, and complicating the process of establishing new relationships. However, it also accelerates development by facilitating closer and more mature relationships with parents and giving young people wisdom and insight not shared by peers. Cancer profoundly shapes how young people conduct their relationships. These changes require ongoing accommodation by young people with cancer, their parents, peers, and new acquaintances.
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Affiliation(s)
- Peter Lewis
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | - Kris Smith
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Ian Kerridge
- University of Sydney, Camperdown, New South Wales, Australia
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Sansom-Daly UM, Wakefield CE. Distress and adjustment among adolescents and young adults with cancer: an empirical and conceptual review. Transl Pediatr 2013; 2:167-97. [PMID: 26835313 PMCID: PMC4729076 DOI: 10.3978/j.issn.2224-4336.2013.10.06] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Adolescents and young adults (AYAs) with cancer must simultaneously navigate the challenges associated with their cancer experience, whilst striving to achieve a number of important developmental milestones at the cusp of adulthood. The disruption caused by their cancer experience at this critical life-stage is assumed to be responsible for significant distress among AYAs living with cancer. The quality and severity of psychological outcomes among AYAs remain poorly documented, however. This review examined the existing literature on psychological outcomes among AYAs living with cancer. All psychological outcomes (both distress and positive adjustment) were included, and AYAs were included across the cancer trajectory, ranging from newly-diagnosed patients, to long-term cancer survivors. Four key research questions were addressed. Section 1 answered the question, "What is the nature and prevalence of distress (and other psychological outcomes) among AYAs living with cancer?" and documented rates of clinical distress, as well as evidence for the trajectory of this distress over time. Section 2 examined the individual, cancer/treatment-related and socio-demographic factors that have been identified as predictors of these outcomes in this existing literature. Section 3 examined current theoretical models relevant to explaining psychological outcomes among AYAs, including developmental models, socio-cognitive and family-systems models, stress-coping frameworks, and cognitive appraisal models (including trauma and meaning making models). The mechanisms implicated in each model were discussed, as was the existing evidence for each model. Converging evidence implicating the potential role of autobiographical memory and future thinking systems in how AYAs process and integrate their cancer experience into their current sense of self and future goals are highlighted. Finally, Section 4 addressed the future of psycho-oncology in understanding and conceptualizing psychological outcomes among AYAs living with cancer, by discussing recent empirical advancements in adjacent, non-oncology fields that might improve our understanding of psychological outcomes in AYAs living with cancer. Included in these were models of memory and future thinking drawn from the broader psychology literature that identify important mechanisms involved in adjustment, as well as experimental paradigms for the study of these mechanisms within analogue, non-cancer AYA samples.
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Affiliation(s)
- Ursula M Sansom-Daly
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia;; School of Psychology, The University of New South Wales, Sydney, Australia; School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia;; School of Women's and Children's Health, The University of New South Wales, Sydney, Australia
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40
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Quinn GP, Huang IC, Murphy D, Zidonik-Eddelton K, Krull KR. Missing content from health-related quality of life instruments: interviews with young adult survivors of childhood cancer. Qual Life Res 2013; 22:111-8. [PMID: 22286223 PMCID: PMC4291119 DOI: 10.1007/s11136-012-0120-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Young adult survivors of childhood cancer (YASCC) are an ever-growing cohort of survivors due to increasing advances in technology. Today, there is a shift of focus to not just ensuring survivorship but also the quality of survivorship, which can be assessed with standardized instruments. The majority of standardized health related quality of life (HRQoL) instruments, however, are non-specific to this age group and the unique late effects within YASCC populations. The purpose of this study was to investigate the relevance and accuracy of standardized HRQoL instruments used with YASCC. METHODS In a previous study, HRQoL items from several instruments (SF-36, QLACS, QLS-CS) were examined for relevance with a population of YASCC. Participants (n = 30) from this study were recruited for a follow-up qualitative interview to expand on their perceptions of missing content from existing instruments. RESULTS Respondents reported missing, relevant content among all three of the HRQoL instruments. Results identified three content areas of missing information: (1) Perceived sense of self, (2) Relationships, and (3) Parenthood. CONCLUSIONS Existing HRQoL instruments do not take into account the progression and interdependence of emotional development impacted by a cancer diagnosis. The themes derived from our qualitative interviews may serve as a foundation for the generation of new items in future HRQoL instruments for YASCC populations. Further testing is required to examine the prevalence, frequency, and breadth of these items in a larger sample.
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Affiliation(s)
- Gwendolyn P Quinn
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC CANCONT, Tampa, FL 33612, USA.
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Song H, Nam Y, Gould J, Sanders WS, McLaughlin M, Fulk J, Meeske KA, Ruccione KS. Cancer survivor identity shared in a social media intervention. J Pediatr Oncol Nurs 2012; 29:80-91. [PMID: 22472482 DOI: 10.1177/1043454212438964] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study investigates how cancer survivors construct their identities and the impact on their psychological health, as measured by depression and survivor self-efficacy. Fourteen young adult survivors of pediatric cancer participated in a customized social networking and video blog intervention program, the LIFECommunity, over a 6-month period. Survivors were asked to share their stories on various topics by posting video messages. Those video blog postings, along with survey data collected from participants, were analyzed to see how cancer survivors expressed their identities, and how these identities are associated with survivors' psychosocial outcomes. In survivors who held negative stereotypes about cancer survivors, there was a positive relationship with depression while positive stereotypes had a marginal association with cancer survivor efficacy. Findings indicate that although pediatric cancer survivors often do not publicly discuss a "cancer survivor identity," they do internalize both positive and negative stereotypes about cancer survivorship. It is important for practitioners to be aware of the long-term implications of cancer survivor identity and stereotypes.
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Affiliation(s)
- Hayeon Song
- University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
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43
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Schweitzer R, Griffiths M, Yates P. Parental experience of childhood cancer using Interpretative Phenomenological Analysis. Psychol Health 2011; 27:704-20. [PMID: 22149644 DOI: 10.1080/08870446.2011.622379] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Whilst survival rates for childhood cancer have improved dramatically over the past three decades, it is still a devastating diagnosis for family members and an illness which severely disrupts the lifestyle of the family unit. Developing an understanding of the impact of the illness on the family is crucial to better support families' deal with the demands of the illness. In this study nine families in which a child was diagnosed with cancer were interviewed twice over a 12 month period, approximately 6 months apart. Using Interpretative Phenomenological Analysis, a semi-structured interview was used to explicate parent's experience of childhood cancer. The results revealed five super-ordinate themes; (1) a pivotal moment in time, (2) the experience of adaptation in relation to having a sick child, (3) the nature of support, (4) re-evaluation of values during a critical life experience and (5) the experience of optimism and altruism. Findings indicate that parents express both negative and positive experiences as they re-evaluate the meaning and purpose of life, seek to redefine themselves, often in terms of priorities, relationships, sense of community and achieve degrees of optimism and altruism. Implications for addressing the needs of parents and for further research are discussed.
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Affiliation(s)
- Robert Schweitzer
- Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Queensland, Australia.
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Huang IC, Quinn GP, Krull K, Eddleton KZ, Murphy DC, Shenkman EA, Shearer PD. Head-to-head comparisons of quality of life instruments for young adult survivors of childhood cancer. Support Care Cancer 2011; 20:2061-71. [PMID: 22105163 DOI: 10.1007/s00520-011-1315-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 11/01/2011] [Indexed: 01/22/2023]
Abstract
PURPOSE Few studies examine the relevance of health-related quality of life (HRQOL) instruments for young adult survivors of childhood cancer (YASCC). This study compared the psychometric properties of two survivor-specific instruments, the Quality of Life-Cancer Survivor (QOL-CS) and Quality of Life in Adult Cancer Survivor (QLACS). METHODS Data from 151 YASCC who enrolled in cancer/tumor registries of two medical centers were used. We examined construct validity by conducting confirmatory factor analysis using indices of chi-square statistic, comparative fit index, and root mean square error of approximation. We examined convergent/discriminant validity by comparing Pearson's correlation coefficients of homogeneous (e.g., physical functioning and pain) of both instruments versus heterogeneous domains (e.g., physical and psychological functioning). We assessed known-groups validity by examining the extent to which HRQOL differed by late effects and comorbid conditions and calculated relative validity (RV) defined as contrasting F-statistics of individual domains to the domain with the lowest F-statistic. Superior known-groups validity is observed if a domain of one instrument demonstrates a higher RV than other domains of the instruments. RESULTS YASCC data cannot replicate the constructs both instruments intend to measure, suggesting poor construct validity. Correlations of between-homogeneous and between-heterogeneous domains of both instruments were not discernible, suggesting poor convergent/discriminant validity. Both instruments were equally able to differentiate HRQOL between YASCC with and without late effects and comorbid conditions, suggesting similar known-groups validity. CONCLUSIONS Neither instrument is superior. Item response theory is suggested to select high-quality items from different instruments to improve HRQOL measure for YASCC.
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Affiliation(s)
- I-Chan Huang
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL 32610, USA.
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Huang IC, Quinn GP, Wen PS, Shenkman EA, Revicki DA, Krull K, Li Z, Shearer PD. Using three legacy measures to develop a health-related quality of life tool for young adult survivors of childhood cancer. Qual Life Res 2011; 21:1437-50. [PMID: 22101901 DOI: 10.1007/s11136-011-0055-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little attention has been paid to selecting and developing health-related quality of life (HRQOL) measurement tools for young adult survivors of childhood cancer (YASCC). The primary purpose of this study was to develop a HRQOL tool for YASCC based on three legacy instruments. METHODS Data collected from 151 YASCC were analyzed. HRQOL was measured using the Medical Outcomes Study SF-36, Quality of Life in Adult Cancer Survivors, and Quality of Life-Cancer Survivor. We used the following stages to develop our HRQOL tool: mapping items from three instruments into a common HRQOL construct, checking dimensionality using confirmatory factor analyses (CFA), and equating items using Rasch modeling. RESULTS We assigned 123 items to a HRQOL construct comprised of six generic and eight survivor-specific domains. CFA retained 107 items that meet the assumptions of unidimensionality and local independence. Rasch analysis retained 68 items that satisfied the indices of information-weighted/outlier-sensitive fit statistic mean square. However, items in most domains possess relatively easy measurement properties, whereas YASCC's underlying HRQOL was on the middle to higher levels. CONCLUSIONS Psychometric properties of the established tool for measuring HRQOL of YASCC were not satisfied. Future studies need to refine this tool, especially adding more challenging items.
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Affiliation(s)
- I-Chan Huang
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
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Nightingale CL, Quinn GP, Shenkman EA, Curbow BA, Zebrack BJ, Krull KR, Huang IC. Health-Related Quality of Life of Young Adult Survivors of Childhood Cancer: A Review of Qualitative Studies. J Adolesc Young Adult Oncol 2011; 1:124-132. [PMID: 23610733 PMCID: PMC3621306 DOI: 10.1089/jayao.2011.0033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The occurrence of late effects, combined with traditional growth and developmental issues, can significantly affect the health-related quality of life (HRQOL) of young adult survivors of childhood cancer (YASCC). Limited HRQOL measurement tools have been developed or validated for YASCC. The purpose of this study was to identify the domains of HRQOL that are unique to YASCC by conducting a systematic review of qualitative studies. Specifically, we compared the findings to the classical framework of HRQOL that was developed for survivors of adult-onset cancer and identified specific domains not being assessed in existing HRQOL instruments for YASCC. Methods: We searched qualitative studies published in peer-reviewed journals from 2000 to 2010 in the PsychINFO, PubMed, and EBSCOhost databases. A set of keywords and inclusion/exclusion criteria were utilized to identify eligible studies with a focus on survivorship and HRQOL issues of YASCC. Results: Sixteen studies met the inclusion/exclusion criteria and were investigated in this study. Six important domains of HRQOL were identified (physical, social, psychological, spiritual, fertility/sexual, resilience, and body appearance) with several sub-domains. Conclusion: Use of the classical HRQOL framework and existing instruments is not comprehensive enough for YASCC. Adding unique domains to the classical framework and existing instruments will make them valuable tools for measuring the HRQOL of YASCC and increase health professionals' ability to identify if and when psychosocial services are needed for this unique population.
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Affiliation(s)
- Chandylen L. Nightingale
- Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Gwendolyn P. Quinn
- Department of Oncologic Sciences, College of Medicine, University of South Florida, and Health Outcomes and Behavior Program, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Policy, and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida
| | - Barbara A. Curbow
- Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | | | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - I-Chan Huang
- Department of Health Outcomes and Policy, and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida
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Jones BL, Parker-Raley J, Barczyk A. Adolescent cancer survivors: identity paradox and the need to belong. QUALITATIVE HEALTH RESEARCH 2011; 21:1033-1040. [PMID: 21447805 DOI: 10.1177/1049732311404029] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Adolescent cancer survivors face psychological effects that can include isolation, poor peer relations, anxiety, depression, and fear of recurrence, which can increase their risk for psychological late effects and poor health posttreatment. The purpose of this exploratory analysis was to understand the experiences of adolescent cancer survivors, with a particular focus on identity, health promotion, and meaning making. In-depth interviews were conducted with 12 adolescent cancer survivors. Constant comparative analysis was used to identify core themes from the data. Findings revealed that adolescent survivors might experience an identity paradox when making the transition to "survivor," which can contribute to their sense of isolation and risk of health-detracting behaviors. Health promotion, prevention, and supportive programs need to be developed for health care professionals to address the isolation and identity transition needs of adolescent cancer survivors.
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Rabin C, Simpson N, Morrow K, Pinto B. Behavioral and psychosocial program needs of young adult cancer survivors. QUALITATIVE HEALTH RESEARCH 2011; 21:796-806. [PMID: 20705863 DOI: 10.1177/1049732310380060] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Behavioral interventions for cancer survivors have historically targeted older adults or young adult survivors of childhood cancer. In this study, 18- to 39-year-olds diagnosed with cancer during young adulthood were interviewed to identify the types of behavioral and psychosocial programs needed. These young adult cancer survivors were also asked to identify potential barriers to program utilization. Participants expressed interest in programs targeting physical activity, relaxation, emotional support, provision of cancer-related and other information, and nutrition/weight loss. Emergent themes included the importance of choice, flexibility, convenience, and similarity to other program participants. Barriers to participation included practical barriers (e.g., limited time), lack of awareness of programs, health issues (e.g., fatigue), and psychosocial barriers (e.g., low motivation). Results highlight a range of unmet psychosocial and behavioral needs among young adult cancer survivors. This information can be used to develop interventions for this population.
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Affiliation(s)
- Carolyn Rabin
- Miriam Hospital, Providence, Rhode Island 02903, USA.
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Casillas J, Kahn KL, Doose M, Landier W, Bhatia S, Hernandez J, Zeltzer LK. Transitioning childhood cancer survivors to adult-centered healthcare: insights from parents, adolescent, and young adult survivors. Psychooncology 2011; 19:982-90. [PMID: 20017115 DOI: 10.1002/pon.1650] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine Latino adolescent and young adults (AYA) cancer survivors' perceived barriers or facilitators to transition from pediatric to adult-centered survivorship care and to also assess the parents' perspective of care. METHODS Partnering with a community-based organization that serves Latino survivors, we conducted a qualitative, constant comparative analytic approach exploring in-depth themes that have salience for Latino pediatric cancer survivors seeking care in the adult healthcare setting. Twenty-seven Latino AYA survivors (>or=15 years of age) completed key informant interviews and 21 Latino parents participated in focus groups. RESULTS Both AYA survivors and parents identified two major facilitative factors for survivorship care: Involvement of the nuclear family in the AYA's survivorship care in the adult healthcare setting and including symptom communication in late effects discussions. Barriers to care included: perceived stigma of a cancer history and continued emotional trauma related to discussions about the childhood cancer experience. CONCLUSIONS Barriers to survivorship care include cancer stigma for both patient and nuclear family, which can impact on seeking survivorship care due to constraints placed on discussions because it remains difficult to discuss 'cancer' years later. Future research can evaluate if these findings are unique to Latino childhood cancer survivors or are found in other populations of AYA cancer survivors transitioning to adult-centered healthcare. This community-based participatory research collaboration also highlights the opportunity to learn about the needs of childhood cancer survivors from the lens of community leaders serving culturally diverse populations.
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Affiliation(s)
- Jacqueline Casillas
- David Geffen School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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