"It Changed Our Outlook on How We Want to Live": Cancer as a Transformative Health Experience for Young Adult Survivors and Their Family Members

Getting back on track after treatment of cancer: A qualitative interview study of cancer survivors' experiences

OBJECTIVE

An increasing number of people resumes life after cancer treatment. Although the (long-term) side-effects of cancer and its treatment can be significant, less is known about the impact on cancer survivors' participation in daily life. The aim of this study was to explore the common experiences of cancer survivors in resuming life after treatment.

METHODS

A semi-structured interview study was conducted among 22 cancer survivors having a favorable prognosis after treatment. Purposive sampling was used to select a variable sample in terms of diagnoses (e.g. breast cancer, colorectal cancer, melanoma), age (18-77 years), and time after diagnosis (0-7 years). Interviews were audio-taped, transcribed verbatim and analyzed in a thorough thematic analysis.

RESULTS

Four main themes were identified. First, cancer survivors reported an emotional fallout episode to often follow treatment, which was characterized by a loss of direction and control due to discontinuation of medical care, decreased support from healthcare professionals and their social network, and an emotional set back. Second, survivors experienced challenges with getting back on track such as the impact of impaired physical and cognitive functions, and challenges and uncertainty related to work and finances. Third, in coping with changes and regaining trust they tried to find a balance between dealing with patient stigma and fear of recurrence on the one hand, and maintaining a positive mindset on the other hand. Fourth, the disease often led to re-evaluating values in life, health and work, which included realizing and accepting change and having a more conscious outlook on life.

CONCLUSION

In resuming life after treatment, cancer survivors experience several challenges and changes in values in different life domains that extend beyond the specific diagnosis. To improve supportive care, healthcare professionals should focus on the (changed) individual needs and values of survivors in the domains considered relevant to them.

Experts of their own experience: adolescent and young adult cancer patients' advice-giving as a coping mechanism

BACKGROUND

To better understand informal coping strategies among adolescents and young adults (AYAs) with cancer, the current investigation asked AYA study participants to describe the 'advice' they would offer to hypothetical peers about coping following diagnosis. This study explores the utility of the single item 'advice' prompt for supportive oncology research and practice.

METHODS

AYA cancer patients (n = 27) aged 12-25 years were recruited through electronic health record query at a single-institution health system. Participants completed semi-structured interviews. Inductive themes were described regarding advice about informal coping strategies following cancer diagnosis. The Institutional Review Board approved this study (HUM#00157267).

RESULTS

Emergent advice themes included (1) attitude re/framing, (2) engage support network, and (3) self-advocacy. Participants advised cultivating a positive yet realistic attitude about the present and future. Reaching out to support network members and accepting help were advised, as was rebuffing unhelpful support. Participants also advocated for addressing medical information needs and building trusting relationships with clinicians.

CONCLUSIONS

Soliciting AYA advice serves to identify informal coping mechanisms in response to life-stage-specific concerns. Future research is called to substantiate the utility of 'advice' as a single item tool for research and clinical questionnaires. Practice implications call for creating opportunities for AYAs to impart their advice to others (e.g. anonymous community message board) as a means of personal catharsis, altruistic service, and legitimizing AYAs as 'embodied' experts of their own experiences.

Exploring the Barriers to Social Support Interactions: A Qualitative Study of Young Adult Cancer Patients and Young Adult Supporters

This study explores the reasons why young adults (ages 18-39) struggle to provide or avoid providing support to young adult cancer patients. The study also explores young adult cancer patients' perceptions of why they have not received support from individuals who did not provide support. A total of 722 reasons were collected through online surveys and analyzed: 438 were provided by young adults who knew a young adult with cancer (N = 131), and young adult cancer patients (N = 111) provided 284 reasons why they believe they did not receive support. Initially using a previous typology of 16 nonsupport reasons, an abductive thematic analysis yielded a total of 21 barriers to the provision of social support. These barriers were categorized across four higher-order categories: recipient-focused, supporter-focused, relationship-focused, and context-focused. Some reasons provided by young adult supporters were not provided by young adult patients and vice versa, suggesting the potential for discrepancies between why cancer patients believe they did not receive support and nonsupporters' actual reasons for not providing support. These various reasons why people struggled to provide support or avoided providing support can act as a list of barriers that future researchers and practitioners can address through the development of resources and interventions aimed at fostering adequate support provision throughout individuals' cancer experiences. Cancer patients can address the experience of nonsupport by individuals in their lives by being more direct in communicating their support desires and, when unsuccessful, using cognitive reappraisal strategies.

"I have to get up and exercise because that's how I'm going to get over this": a qualitative exploration of exercise identity and behavior in early cancer survivorship

PURPOSE

Exercise is beneficial for people living with and beyond cancer (LWBC); however, many people LWBC fail to meet the exercise guidelines. Having an identity related to exercise, a component of one's self-concept, correlates with exercising more frequently in general adult populations. Understanding how exercise identity influences exercise behaviors in people LWBC is warranted due to the many barriers people LWBC face in relation to physical activity. The purpose of this study was to explore the perceived impact of an exercise identity of the exercise behaviors and motivations among people LWBC.

METHODS

Thirteen participants of mixed diagnoses (Mage = 60.8 ± 10.8 years) in the early survivorship period (i.e., within five years of primary treatment completion or diagnosis) participated in semi-structured interviews to identify influences of exercise identity on exercise behavior. Interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Findings demonstrated that people LWBC with a strong exercise identity engage in high and varied exercise behaviors. Despite barriers such as changes in motivations and ability to engage in exercise, participants maintained exercise throughout cancer by constant adaptation of their outlook and behaviors related to exercise. These results demonstrate a maintenance of physical activity in relation to a strong exercise identity.

IMPLICATIONS FOR CANCER SURVIVORS

Results of this study have implications for the design and implementation of exercise behavior change programs for people LWBC as it provides insights into predictors of sustained exercise behavior during and following cancer treatment.

A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model

Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.

Nonsupport Experiences of Young Adult Cancer Patients: Prevalence, Acceptability, and Outcomes of Not Receiving Support

This study provides foundational data regarding instances of nonsupport (i.e. instances when support was expected from someone but not received) in the cancer context. In a sample of 205 young adult cancer patients from 22 countries, approximately three out of every five patients reported having experienced nonsupport at some point during their cancer journey. Men and women patients were approximately equally as likely to have experienced nonsupport and were approximately equally likely to be recalled by a cancer patient as a nonsupporter. Results showed that patients who had experienced nonsupport reported worse mental and physical health, greater depression, and greater loneliness than those who had not experienced an instance of nonsupport. Patients were also presented with a previously published list of 16 reasons why people choose to forgo communicating support to cancer patients, and patients rated each reason's acceptability. Nonsupport reasons that assumed communicating support would create a burden for the patient (e.g. providing support would create a privacy issue; the supporter feared losing control of their own emotions) were rated as more acceptable. Reasons involving the nonsupporter making assumptions or decisions about the broader social support process were seen as less acceptable (e.g. communicating support does not help; assuming support is not desired). Together, these results demonstrate the prevalence and impact of nonsupport on cancer patients' health outcomes and provide justification for nonsupport as an important avenue for future social support research.

Experiences of Women With Breast Cancer and Their Partners in Achieving Coherence as a Couple During the Disease Journey

OBJECTIVE

To describe the experiences of female patients with breast cancer and their partners in achieving coherence as a couple during the disease journey.

DESIGN

Qualitative study.

SETTING

Colombia, South America.

PARTICIPANTS

Women diagnosed with breast cancer in the last 2 years and their intimate partners with whom they lived during the 6 months before study enrollment. In total, 16 heterosexual couples participated in individual interviews and focus groups.

METHOD

Interviews and focus groups were analyzed using content analysis.

RESULTS

Four themes were identified: The Diagnosis: A Moment That Destabilizes the Couple, Couple's Sexuality: Seeking the Best Conditions Between Desire and Reality, Generating Mutually Supportive Dynamics in the Face of Cancer, and The Transformation of a Negative Situation Into a Positive One and Achieving Coherence Within the Couple. The first theme represents the initial moment of uncertainty and emotional reactions due to the confirmation of the diagnosis of breast cancer. The second captures the physical and emotional effects in the couple's sexuality generated by the treatment and diagnosis as well as the strategies used to strengthen the couple's relationship. The third reflects how the couple's support is based on commitment, companionship, and the performance of daily actions. The last describes how the adaptation process allows couples experiencing the disease to achieve coherence.

CONCLUSION

These findings highlight that couples experiencing breast cancer can transform the negative situation into an opportunity to strengthen their relationship by achieving coherence. Future research is needed to investigate the antecedents, attributes, and outcomes related to couples' coherence. Moreover, health professionals should perform periodic assessments on the dynamics, coping strategies, and resources at couples' disposal to help promote couples' adaptation and coherence.

"You nearly feel a little bit like you've less right to grieve": a qualitative study on the impact of cancer on adult siblings

PURPOSE

Family members of cancer patients experience a range of challenges and are impacted in various ways by cancer. To our knowledge, the impact of cancer on adult siblings has yet to be explored. Sibling relationships are one of the longest relationships individuals have across the lifespan. Thus, the current study sought to investigate the perspectives of siblings of those who previously had cancer.

METHODS

Ten participants were recruited using purposive sampling. A qualitative, cross-sectional design was implemented with both virtual and in-person semi-structured interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis.

RESULTS

The researchers identified five themes relating to both the impact of cancer on siblings and the supports they received: changes in family relationships, sibling's grief is forgotten, benefits of social support networks, supporting their sibling and caregiving and self-support.

CONCLUSIONS

Cancer organizations and support services should focus on signposting services for siblings in order to ensure they can access support. Further research is needed with siblings to gain greater insight into what supports siblings feel are available for them to access, whether there are any for them to access or how supports can be improved.

IMPLICATIONS FOR CANCER SURVIVORS

The provision of appropriate psychological support for siblings of cancer patients will ensure they can provide optimal support and care to their siblings. This will in turn benefit cancer patients along their cancer trajectory as adequate support from their caregivers will enhance their quality of life.

Caring for Adolescents and Young Adults (AYA) with Cancer: A Scoping Review into Caregiver Burdens and Needs

AYAs with cancer (aged 15 to 39 at primary diagnosis) form a specific group within oncology, and there is limited information on the impact on their informal caregivers. This scoping review aimed to gain insight into the burden on caregivers of AYAs with cancer and identify the unmet needs they might have. Eligible articles focused on impacts in one of the domains of caregiver burden (physical, psychological, social, on schedule, financial) or unmet needs. In all domains of caregiver burden, impact was reported by caregivers. Caregiving leads to physical problems (such as sleep problems) and psychological symptoms (e.g., depression, anxiety, and negative emotions). Loneliness is reported, and little peer-support. Many different tasks and roles must be undertaken, which is perceived as challenging. In addition, there is a financial impact and there are unmet needs to be met. Several domains of the lives of caregivers of AYA cancer patients are negatively affected by the disease. Some of these are age-specific, and tailored to a particular group of caregivers (parents, partners, or friends). AYA cancer patients represent a wide age range, resulting in the engagement of many different caregivers. Future research will need to take this into account in order to adequately provide support.

'Make Them Wonder How You Are Still Smiling': The Lived Experience of Coping With a Brain Tumour

A brain tumour can be a life-threatening illness and cause unique symptoms compared to other types of cancer, such as cognitive or language deficits, or changes in personality. It is an exceptionally distressing diagnosis which can affect quality of life, even for those with a low-grade tumour or many years after the diagnosis. This study sought to gain an in-depth understanding of the lived experience of adjustment to living with a brain tumour. Twelve individuals (83% female) with a primary brain tumour (83% low-grade) took part in the study. Participants were aged 29-54 years, on average 43 months following the diagnosis, and were recruited through the charitable support organisations in the United Kingdom. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). Six inter-related themes were identified: making sense of the diagnosis, seeking empowerment, feeling appreciative, taking charge of coping, learning to accept, and negotiating a new normality. Notions of empowerment, gratitude, and acceptance throughout the illness journey were prominent in the participants' narratives. Receiving sufficient information and initiating treatment were important in negotiation of control. The results highlighted what facilitates and hinders adaptive coping. Aspects which facilitated positive coping were as follows: trust in clinician, feeling in control, feeling grateful, or accepting. Participants on a 'watch and wait' approach, while feeling appreciative, perceived the lack of treatment as difficult and frustrating. Implications for patient-clinician communication are discussed, particularly for patients on a 'watch and wait' who might need additional support in adjusting.

"Your Body Is Not At All Where You Left It": Adolescent and Young Adult Cancer Survivors' Experiences Transitioning Back Into Physical Activity After Treatment

Physical activity (PA) can help manage cancer treatment-related side effects and improve well-being following treatment; however, resuming PA after a period of inactivity due to cancer can be challenging. The purpose of this study was to explore adolescents and young adults (AYAs) experiences transitioning back into PA after a period of inactivity due to cancer treatment. Twelve previously active AYAs (M_age = 30 ± 5.8 years) were purposefully sampled and engaged in a semi-structured interview. The following four themes were generated through a reflexive thematic analysis: PA is described as important and valuable; navigating one's appearance and fitness changes after cancer treatment within the PA context; supportive care is essential to successful PA transitions; and juxtaposed environments: fitness facilities, cities, and green spaces. Developing strategies aimed at gradually transitioning into PA should be a priority to improve AYAs' well-being through survivorship.

Cancer-Related Decision-Making Among Adolescents, Young Adults, Caregivers, and Oncology Providers

Decision-making among adolescents and young adults with cancer (AYA) is often complex, ongoing, and multifaceted, involving caregiver and oncology provider perspectives. Engagement in decision-making against the backdrop of normative developmental processes of acquiring autonomy and gaining independence contributes to the complexity of decision-making. Semi-structured qualitative interviews from 11 AYA and caregiver dyads and eight oncology providers examined decision-making processes with specific attention to the role of shared decision-making, cognitive and emotional processes, and coping with the decision-making experience. Five decision-making patterns were identified, with collaborative decision-making and AYA-driven decisions most commonly described. Utilizing hypothesis coding, AYA and caregivers explained how cognitive (i.e., pros/cons) and emotional (i.e., shock and fear of missing out) processes influenced cancer-related decisions. Coping strategies provided clarity and respite when engaged in decision-making. Our findings illuminate important implications for how to best support decision-making among AYA and caregivers, including the role oncology providers can play during decision-making.

Emotional approach coping among young adults with cancer: Relationships with psychological distress, posttraumatic growth, and resilience

OBJECTIVE

Cancer, particularly, during young adulthood, can evoke difficult emotions, interfere with normative developmental activities, and challenge coping responses. Emotion-regulating coping efforts aimed at active emotional processing (EP) and emotional expression (EE) can be beneficial to cancer adjustment and perceptions of positive growth. However, it may be that EP and EE work differently to influence well-being. This study examines relationships of EP and EE with psychological distress, posttraumatic growth (PTG), and resilience. We expect that EP will be positively associated with PTG and resilience, whereas EE will be negatively associated with psychological distress.

METHODS

Young adults with cancer (M age  = 34.68, N = 57) completed measures of emotional; approach coping (EP and EE), psychological distress (depressive symptoms, fear of cancer; recurrence [FCR]) and indicators of positive adjustment and growth (resilience and PTG).

RESULTS

Greater use of EP was associated with higher resilience (β = 0.48, p = 0.003) and PTG (β = 0.27, p = 0.05), whereas greater use of EE was associated with lower resilience (β = -0.33, p = 0.04). The EE × EP interaction was significant for FCR (β = 0.29, p = 0.04) such that low EE was associated with lower FCR in those with high EP. Interaction effects were not significant for depressive symptoms, resilience, or PTG.

CONCLUSIONS

Findings highlight differing relationships between EP and EE among young adults with cancer. Interventions aimed at increasing emotion-regulating coping strategies may prove useful in facilitating positive adjustment and growth, strengthening young adults' ability to cope with the diverse effects of disease, treatment, and survivorship.