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Chauhan A, Chitkara U, Walsan R, Sansom-Daly UM, Manias E, Seah D, Dalli A, El-Kabbout N, Tieu T, Sarwar M, Faiz M, Huang N, Rocha VM, Pal A, Harrison R. Co-designing strategies to improve advance care planning among people from culturally and linguistically diverse backgrounds with cancer: iCanCarePlan study protocol. BMC Palliat Care 2024; 23:123. [PMID: 38760714 PMCID: PMC11102140 DOI: 10.1186/s12904-024-01453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/08/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) describes the process of supporting individuals at any age or stage of health to consider and share their personal values, life goals, and preferences regarding future health care. Engaging in ACP is associated with better-quality of care in which people receive care in lines with their wishes, values and preferences. Direct translations of ACP guides and resources do not attend to the considerable inter- and intra-ethnic variations in cultural and religious or spiritual beliefs that shape preferences among people from culturally and linguistically diverse (CALD) backgrounds. ICanCarePlan is a three-year project that aims to determine the prevalence of ACP documentation among people from CALD backgrounds with cancer, identify resources available and their use to support ACP among CALD communities, identify barriers and facilitators of person-centred ACP, and to develop, through co-design with consumers and clinicians, approaches that enhance the process ACP for people from CALD backgrounds. METHOD A mixed-method sequential approach will be used comprising of four studies. Study one is retrospective medical record review of approximately 1500 medical records to establish the prevalence of ACP documentation among CALD patient records in cancer services. Study two is a document analysis synthesising the resources available in the Australian health system to support ACP. Study three is a qualitative study with healthcare staff and consumers to explore barriers and enablers of person-centred ACP. Evidence generated from studies one to three will inform the conduct of co-design with stakeholders to develop approaches to improve ACP processes among CALD communities. Language, technical and financial support for meaningful involvement with consumers from CALD backgrounds throughout this project is outlined. A plan for distress management is also made due to sensitive nature of the topic. The research project has also established a project steering group consisting of three consumer members who are from CALD backgrounds. DISCUSSION The project will address a national priority issue for a growing population of CALD communities in Australia. The project will provide novel evidence of ACP among CALD communities and novel strategies developed with stakeholders to enhance uptake and experiences of ACP.
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Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia.
| | - Upma Chitkara
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
| | - Ramya Walsan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, Randwick Clinical Campus, UNSW Sydney, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Davinia Seah
- Sacred Heart Supportive and Palliative Care, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Angie Dalli
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW, Australia
| | | | - Thit Tieu
- Sisters' Cancer Support Group Inc., Sydney, NSW, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Mashreka Sarwar
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Misbah Faiz
- District Clinical Governance, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Nancy Huang
- Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Sydney, NSW, Australia
| | | | - Abhijit Pal
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, NSW, Australia
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Nickel S, Helmreich I, Broll J, Lüdecke D. Family health partners in regional network structures (NEST): A non-randomized controlled trial among parents of chronically ill and disabled children. PLoS One 2023; 18:e0288435. [PMID: 37459306 PMCID: PMC10351712 DOI: 10.1371/journal.pone.0288435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The overarching project goal is to evaluate the effectiveness of a cross-sectoral and cross-service provider offering professional support for families with chronically ill and disabled children: so-called Family Health Partners (in German: 'Familien-Gesundheits-Partner' or FGP). This needs-oriented service, which is anchored in regional networks, aims to provide 'holistic' support for families with children in need of care. METHODS We are carrying out a non-randomized controlled trial with four points of measurement (t0-t3 in 18 months), beginning in January 2022. Both intervention and control group include 102 families. Primary outcome measure is the quality of life, secondary outcomes are resilience factors and associated measures as well as the access to care. Multilevel regression models will be used to analyze the longitudinal data. DISCUSSION The strength of this study is that it looks at the health and resilience of all family members involved by examining how a FGP can influence the entire family system with regard to increasing quality of life, resilience and self-efficacy. The network structures of FGP also open up better to previously unknown regional supply offers. There are, however, a number of limitations (e.g. type of outcomes, sample size). TRIAL REGISTRATION This study was first registered on the German Clinical Trials Register before enrolment of participants started (ID: DRKS00027465, 4 January 2022). In order to promote its dissemination, it was also retrospectively registered on ClinicalTrials.gov (ID: NCT05418205, 14 June 2022).
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Affiliation(s)
- Stefan Nickel
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jan Broll
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Xu RH, Bao XL, Shi LSB, Wang D. Associations between eHealth literacy, mental health-seeking attitude, and mental wellbeing among young electronic media users in China during the COVID-19 pandemic. Front Public Health 2023; 11:1139786. [PMID: 36908426 PMCID: PMC9998951 DOI: 10.3389/fpubh.2023.1139786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/09/2023] [Indexed: 03/14/2023] Open
Abstract
Objective This study aimed to examine the associations among mental health related eHealth literacy (eHL), mental health-seeking attitude, and wellbeing among Chinese young electronic media users during the COVID-19 pandemic. Methods A web-based cross-sectional survey was conducted in Guangzhou, China. The modified eHealth literacy Scale, Mental Help-Seeking Attitudes Scale, and Short Warwick-Edinburgh Mental Wellbeing Scale were used. Structural equation modeling (SEM) examined the associations between them and was adjusted by several controlled variables. Results Totally, 1,008 participants completed the questionnaire and provided valid responses. The eHL showed a statistically significant and direct effect on mental wellbeing in this sample. The higher the level of eHL, the better wellbeing of the participants. The mental health-seeking attitude is also positively correlated with mental wellbeing, indicating that the more positive attitude toward seeking mental health services, the better the wellbeing participants reported. The higher level of eHL is significantly associated with a more positive attitude toward seeking mental health services. Conclusion Training to improve eHL may optimize young electronic media users' mental health outcomes. Development and use of a mental health specific eHL instrument in future studies should be encouraged.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiao-Lu Bao
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Lu-Shao-Bo Shi
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China.,Institute of Health Management, Southern Medical University, Guangzhou, China
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Hao R, Jin H, Zuo J, Zhao R, Hu J, Qi Y. Quality assessment of clinical practice guidelines on psychological distress of cancer patients using the AGREE II instrument. Front Oncol 2022; 12:942219. [PMID: 36016612 PMCID: PMC9396033 DOI: 10.3389/fonc.2022.942219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to assess the quality of the clinical practice guidelines on psychological distress among cancer patients and provide users with recommendations for coping with psychological distress. Methods A systematic search of relevant clinical practice guidelines was undertaken to identify and select the clinical practice guidelines related to psychological distress among cancer patients. Literature databases were searched in PubMed, Web of Science, Excerpta Medica Database, the Cumulative Index to Nursing & Allied Health Literature, China Biology Medicine, China National Knowledge Infrastructure, WanFang and Weipu Journal Database. The guideline databases include Yimaitong Guidelines Network, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, American Society of Clinical Oncology (ASCO), New Zealand Guidelines Group, Scottish Intercollegiate GuidelinesNetwork, American Psychological Association, Registered Nurses' Association of Ontario and Cancer Care Ontario (CCO). Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results Six clinical practice guidelines were included and assessed for critical evaluation. The median score for the scope and purpose domain was 71.5% (IQR 64%-77.25%), the stakeholder involvement domain was 65% (IQR 47.5%-74.5%), the rigour of the development domain was 61.5% (IQR 45.5%-85.25%), the clarity of the presentation domain was 91% (IQR 72.25%-94.5%), the applicability domain was 70% (IQR 33%-78.75%), and the editorial independence domain was 48.84% (IQR 61.75%-95%). Four guidelines (ASCO, 2014; Canadian Association of Psychosocial Oncology, 2015; NCCN, 2020, and CCO, 2016) were classified as "recommended," and the remaining (European Palliative Care Research Collaborative and Chinese Psychosocial Oncology Society) were "recommended with modifications," especially in the domains of Stakeholder involvement, rigour of development, and applicability. The inter-rater consistency of each domain showed moderate level (0.52-0.90) analyzing by intraclass correlation. Conclusions The clinical practice guidelines on psychological distress among cancer patients varied in quality, and there were discrepancies in terms of the recommendations and recommendation grades. These findings could contribute to improving the quality of clinical practice guidelines on psychological distress, and enable the development and implementation of evidence-based guidelines for cancer patients. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42020209204.
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Affiliation(s)
- Ran Hao
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Haoyu Jin
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jinfan Zuo
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Rumeng Zhao
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jie Hu
- Department of Science and Technology, Hebei Medical University, Shijiazhuang, China
| | - Yixin Qi
- Department of Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Li L, Wang L, Duan Y, Xiao P, Zhou Y, Luo X, Liu X, Xie J, Cheng ASK. Intelligent physical activity versus modified behavioral activation in adolescent and young adult cancer patients with psychological distress: A randomized, controlled pilot trial. Cancer Med 2022; 12:1935-1948. [PMID: 35848716 PMCID: PMC9883549 DOI: 10.1002/cam4.5030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND More than 80% of adolescent and young adult cancer patients (AYACPs) experienced psychological distress. Physical activity and behavioral activation are effective to relieve the psychological distress in AYACPs. METHODS Participants aged 15-39 years diagnosed with malignant tumors were included. A total of 143 eligible AYACPs were randomly assigned to three groups. The treatment-as-usual group (N = 48) received routine care, the physical activity group (N = 47) received 8 weeks of physical activity program based on intelligent wearable devices, and the behavioral activation group (N = 48) received an internet-based modified behavioral activation program for 8 weeks. Objective outcome measures included salivary cortisol and testosterone. RESULTS Linear mixed-model analyses showed significant differences between treatment-as-usual, physical activity and behavioral activation in salivary cortisol, as well as total scores on depression and anxiety, physical activity, self-efficacy, and social support. Significantly stronger effect sizes for physical activity group compared with behavioral activation group were found on physical activity (d = 0.53) (1 week after intervention), moderate activity (d = 0.61), and walking activity (d = 0.57) (3-month follow-up). CONCLUSIONS Intelligent, wearable, device-based physical activity program is more effective in alleviating anxiety and depression, reducing saliva cortisol, and improving physical activity in AYACPs than internet-based modified behavioral activation program. Intelligent, wearable, device-based physical activity program can reduce the time cost of AYACPs to ensure that the intervention is carried out.
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Affiliation(s)
- Lijun Li
- The Third Xiangya Hospital of Central South UniversityChangshaChina,Xiangya Nursing School of Central South UniversityChangshaChina
| | - Lu Wang
- Xiangya Nursing School of Central South UniversityChangshaChina
| | - Yinglong Duan
- The Third Xiangya Hospital of Central South UniversityChangshaChina
| | - Panpan Xiao
- Xiangya Nursing School of Central South UniversityChangshaChina
| | - Yi Zhou
- Xiangya Nursing School of Central South UniversityChangshaChina
| | - Xiaofei Luo
- Xiangya Nursing School of Central South UniversityChangshaChina
| | | | - Jianfei Xie
- The Third Xiangya Hospital of Central South UniversityChangshaChina
| | - Andy S. K. Cheng
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina
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Support needs of Dutch young adult childhood cancer survivors. Support Care Cancer 2022; 30:3291-3302. [PMID: 34981198 PMCID: PMC8723798 DOI: 10.1007/s00520-021-06723-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Studies about support needs of young adult childhood cancer survivors (YACCS) previously focused mainly on information needs. This study assessed support needs and associated factors (sociodemographic, medical, and psychosocial functioning) in Dutch YACCS. METHODS YACCS (aged 18-30, diagnosed ≤ 18 years, time since diagnosis ≥ 5 years) cross-sectionally filled out a questionnaire regarding their need for various types of support (concrete information, personal counseling, and peer contact) in eight domains (physical consequences of childhood cancer, social-emotional consequences, relationships and sexuality, fertility, lifestyle, school and work, future perspective, insurance and mortgage), and questionnaires assessing health-related quality of life (PedsQL-YA), anxiety and depression (HADS), and fatigue (CIS-20R). Descriptive statistics were used to describe support needs. Linear regression was used to identify characteristics associated with support needs. RESULTS One hundred fifty-one YACCS participated (response = 40%). Most YACCS reported a need for support in one or more domains (88.0%, N = 133). More than half of the participants reported a need for concrete information in the domains lifestyle, fertility, and physical consequences of childhood cancer and 25-50% in the domains insurance and mortgages, future perspective, and social-emotional consequences of childhood cancer. In the domains lifestyle and physical as well as emotional consequences of childhood cancer, 25-50% reported a need for counseling. Overall need for support was positively associated with middle (β = 0.26, p = 0.024) and high (β = 0.35, p = 0.014) compared to low educational attainment and (sub)clinical anxiety (β = 0.22, p = 0.017), and negatively associated with social functioning (β = - 0.37, p = 0.002) in multivariate analyses. CONCLUSION YACCS report the strongest need for support, for concrete information, in the domains lifestyle, fertility, and physical consequences of childhood cancer. Associated factors were mostly socioeconomic and psychosocial in nature. Psychosocial care should be an integral part of survivorship care for YACCS, with screening for psychosocial problems, information provision including associated emotional consequences and support if necessary (psycho-education) and tailored interventions, and adequate referrals to more specialized care if necessary.
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Mizrach H, Goshe B, Park ER, Recklitis C, Greer JA, Chang Y, Frederick N, Abrams A, Tower MD, Walsh EA, Huang M, Kenney L, Homans A, Miller K, Denninger J, Usmani GN, Peppercorn J, Perez GK. Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors: Protocol for the Bounce Back Study. JMIR Res Protoc 2022; 11:e34033. [PMID: 35080500 PMCID: PMC8829691 DOI: 10.2196/34033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background The emotional health of adolescent and young adult (AYA) cancer survivors is compromised both during and after cancer treatment. Targeted programs designed to support AYAs’ ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship. Objective Our randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among posttreatment AYAs. Methods Bounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (Stress Management and Resiliency Training - Relaxation Response Resiliency Program [SMART-3RP]) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14 years and 29 years and had completed cancer treatment within the last 5 years) were randomly assigned to the Bounce Back program or waitlist-control group and completed assessments at baseline, 3 months postbaseline, and 6 months postbaseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (ie, anxiety, depression) collected across the 3 time points. Results This study was funded by the National Cancer Institute in July 2017. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board in October 2018 (Protocol 18-428). The randomized trial was conducted from July 2019 to March 2021. Quantitative data collection is complete, and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, or international meetings in the coming years. Conclusions Few evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being. Trial Registration ClinicalTrials.gov NCT03768336; https://clinicaltrials.gov/ct2/show/NCT03768336 International Registered Report Identifier (IRRID) DERR1-10.2196/34033
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Affiliation(s)
- Helen Mizrach
- Massachusetts General Hospital, Boston, MA, United States.,University of Massachusetts Memorial Medical Center, Worcester, MA, United States
| | - Brett Goshe
- Massachusetts General Hospital, Boston, MA, United States
| | - Elyse R Park
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Joseph A Greer
- Massachusetts General Hospital, Boston, MA, United States
| | - Yuchiao Chang
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Annah Abrams
- Massachusetts General Hospital, Boston, MA, United States
| | - Mary D Tower
- Massachusetts General Hospital, Boston, MA, United States
| | - Emily A Walsh
- Massachusetts General Hospital, Boston, MA, United States
| | - Mary Huang
- Massachusetts General Hospital, Boston, MA, United States
| | - Lisa Kenney
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Alan Homans
- University of Vermont Medical Center, Burlington, VT, United States
| | - Karen Miller
- Massachusetts General Hospital, Boston, MA, United States
| | - John Denninger
- Massachusetts General Hospital, Boston, MA, United States
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Zhang A, Weaver A, Walling E, Zebrack B, Levin NJ, Stuchell B, Himle J. Evaluating an engaging and coach-assisted online cognitive behavioral therapy for depression among adolescent and young adult cancer survivors: A pilot feasibility trial. J Psychosoc Oncol 2022; 41:20-42. [PMID: 35040368 PMCID: PMC10599691 DOI: 10.1080/07347332.2021.2011530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Technology-assisted Cognitive Behavioral Therapy (tCBT) has significant potentials to provide engaging and accessible depression treatment for adolescents and young adults (AYAs) coping with cancer. This study evaluated the feasibility and preliminary efficacy of an engaging and tailorable tCBT - Mind Your Total Health (MYTH) - for AYA cancer survivors' depression. METHODS Seventeen AYAs diagnosed with cancer were randomly assigned to either the intervention (MYTH) or control group. The intervention group (n = 10) received eight weekly 30-35 minutes coach-assisted tCBT (MYTH), while the control group (n = 7) received active control, BeatingtheBlues (BtB). RESULTS Eight out of ten participants in the MYTH group completed at least six out of eight sessions, suggesting strong feasibility (80% completion rate) among AYAs with cancer. Efficacy outcomes indicated that participants in the MYTH group reported significant pre- and post-treatment reduction in depression, t(9) = 5.25, p < 0.001, and anxiety, t(9)=5.07, p < 0.001. Notably, participants in the MYTH group reported significantly lower post-treatment depression than participants in the BtB group, t(15) = 2.40, p < 0.05. The between-group difference reflected a significant between-group treatment effect size, d = 1.12, p < 0.05. DISCUSSION This engaging, tailorable, and coach-assisted tCBT intervention is promising in alleviating depression and anxiety among AYA cancer survivors. Future research needs to include larger sample size and a more diverse patient population.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Addie Weaver
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatrics, University of Michigan, Medical School, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Nina Jackson Levin
- School of Social Work & Department of Anthropology, University of Michigan, Ann Arbor, Michigan, USA
| | - Beth Stuchell
- Department of Pediatrics, University of Michigan, Medical School, Ann Arbor, Michigan, USA
| | - Joseph Himle
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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The effects of the COVID-19 pandemic on psychological stress in breast cancer patients. BMC Cancer 2021; 21:1356. [PMID: 34972520 PMCID: PMC8719114 DOI: 10.1186/s12885-021-09012-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023] Open
Abstract
Background The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels pre-COVID-19 pandemic. Methods Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network® (NCCN®) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23. Results Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms. Conclusions This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created “COVID-19 pandemic questionnaire” could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support. Trial registration DRKS-ID: DRKS00022507. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09012-y.
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Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group. Cancers (Basel) 2021; 13:cancers13215270. [PMID: 34771435 PMCID: PMC8582416 DOI: 10.3390/cancers13215270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Adolescent and young adult cancer survivors face several significant physical/mental health late effects following cancer treatment. These effects may be minimized through healthcare use tailored to young survivors’ needs. Using a cross-sectional study design, we examined the healthcare use of 93 adolescent/young adult cancer survivors (aged 15–39 years), relative to a comparison group of adolescents and young adults recruited from the local community (n = 183). Our cancer survivor group reported greater use of medical and mental health services, and medications during the past six months relative to the comparison group. Our cancer survivor group also reported less psychological distress, and similar work/study participation relative to the comparison group. Survivors who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater healthcare use. Future research is needed to determine whether the healthcare accessed by adolescent and young adult cancer survivors is appropriate and meets their needs. Abstract Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.
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Milbury K, Kroll J, Chen A, Antonoff MB, Snyder S, Higgins H, Yang CC, Li Y, Bruera E. Pilot Randomized Controlled Trial in Women With Non-Small Cell Lung Cancer to Assess the Feasibility of Delivering Group-Based Psychosocial Care via Videoconference. Integr Cancer Ther 2021; 20:15347354211052520. [PMID: 34663123 PMCID: PMC8529304 DOI: 10.1177/15347354211052520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The goal of this pilot randomized controlled trial was to examine the
feasibility and acceptability of delivering group-based psychosocial care
via videoconference (ie, Zoom) to women with lung cancer undergoing
treatment. Methods: At baseline, women indicated their typical computer and internet use and were
then randomized to a group-based intervention that either focused on
mindfulness training or psychoeducation. Participants completed 1 Zoom
“practice run” prior to starting the 5 group sessions (1 per week). After
the last session, they evaluated their experiences with the intervention and
its delivery. Results: With a consent rate of 68%, 54 women (mean age = 66 years; 69% non-Hispanic
White; 48% with stage IV disease) were equally randomized. Attendance was
high in both arms (session mean, mindfulness = 4.38; education = 4.75; 85%
attended all sessions). Across arms, all women rated the program as useful;
most preferred group-based delivery (67%) and remote delivery (50%) or had
no preference. Although the sample’s typical computer use was relatively low
(eg, 19% said that they rarely or never use a computer), most women (76%)
indicated that Zoom was “very easy” or “easy” to use. After only 0 to 1
attempts, 56% felt comfortable but 26% stated that they never felt
comfortable with the technology. Conclusions: It seems to be feasible to deliver group-based psychosocial interventions via
videoconference in women with lung cancer undergoing treatment. Challenges
regarding scheduling the group sessions and familiarizing older rather than
infrequent computer users with the technology were encountered but resolved
over the course of the trial.
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Affiliation(s)
- Kathrin Milbury
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | - Juliet Kroll
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | - Aileen Chen
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | - Mara B Antonoff
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | - Stella Snyder
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | - Hannah Higgins
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | | | - Yisheng Li
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
| | - Eduardo Bruera
- The University of Texas, MD Anderson Cancer Center, Houston TX, USA
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12
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Bichard E, Wray J, Aitken LM. Discharged from paediatric intensive care: A mixed methods study of teenager's anxiety levels and experiences after paediatric intensive care unit discharge. Nurs Crit Care 2021; 27:429-439. [PMID: 34405487 DOI: 10.1111/nicc.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. AIM AND OBJECTIVES To measure anxiety that teenagers report 48-96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. DESIGN Two-phase mixed methods, explanatory sequential design. METHODS This single-site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13-18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS-A) was administered on paper and completed with the researcher present. Semi-structured interviews were conducted in-person and over the telephone, audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. RESULTS Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48-96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut-off level for the HADS-A-1 Teenagers described their experiences on PICU within three themes: Memories of treatments, side effects, and the PICU environment Losing a sense of self Feeling cared for CONCLUSIONS: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. RELEVANCE TO CLINICAL PRACTICE Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial.
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Affiliation(s)
- Elizabeth Bichard
- London South Bank University, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR GOSH BRC, London, UK
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13
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Sansom-Daly UM, Wakefield CE, Ellis SJ, McGill BC, Donoghoe MW, Butow P, Bryant RA, Sawyer SM, Patterson P, Anazodo A, Plaster M, Thompson K, Holland L, Osborn M, Maguire F, O’Dwyer C, De Abreu Lourenco R, Cohn RJ. Online, Group-Based Psychological Support for Adolescent and Young Adult Cancer Survivors: Results from the Recapture Life Randomized Trial. Cancers (Basel) 2021; 13:2460. [PMID: 34070134 PMCID: PMC8158368 DOI: 10.3390/cancers13102460] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022] Open
Abstract
Telehealth interventions offer a practical platform to support adolescent and young adult (AYA) cancer survivors' mental health needs after treatment, yet efficacy data are lacking. We evaluated an online, group-based, videoconferencing-delivered cognitive-behavioral therapy (CBT) intervention ('Recapture Life') in a 3-arm randomized-controlled trial comparing Recapture Life with an online peer-support group, and a waitlist control, with the aim of testing its impact on quality of life, emotional distress and healthcare service use. Forty AYAs (Mage = 20.6 years) within 24-months of completing treatment participated, together with 18 support persons. No groupwise impacts were measured immediately after the six-week intervention. However, Recapture Life participants reported using more CBT skills at the six-week follow-up (OR = 5.58, 95% CI = 2.00-15.56, p = 0.001) than peer-support controls. Recapture Life participants reported higher perceived negative impact of cancer, anxiety and depression at 12-month follow-up, compared to peer-support controls. Post-hoc analyses suggested that AYAs who were further from completing cancer treatment responded better to Recapture Life than those who had completed treatment more recently. While online telehealth interventions hold promise, recruitment to this trial was challenging. As the psychological challenges of cancer survivorship are likely to evolve with time, different support models may prove more or less helpful for different sub-groups of AYA survivors at different times.
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Affiliation(s)
- Ursula M. Sansom-Daly
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Sarah J. Ellis
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Brittany C. McGill
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Mark W. Donoghoe
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, NSW 2033, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW 2050, Australia;
| | | | - Susan M. Sawyer
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3052, Australia;
- Royal Children’s Hospital Centre for Adolescent Health, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Pandora Patterson
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia;
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Antoinette Anazodo
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Megan Plaster
- Western Australia Youth Cancer Service, Sir Charles Gairdner Hospital, WA 6009, Australia;
| | - Kate Thompson
- Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
- Department of Social Work, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lucy Holland
- Queensland Child and Youth Clinical Network, Clinical Excellence Queensland, Herston, QLD 4006, Australia;
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Michael Osborn
- Youth Cancer Service SA/NT, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
| | - Fiona Maguire
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
| | - Catherine O’Dwyer
- Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (F.M.); (C.O.)
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, NSW 2000, Australia;
| | - Richard J. Cohn
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, NSW 2033, Australia; (C.E.W.); (S.J.E.); (B.C.M.); (M.W.D.); (A.A.); (R.J.C.)
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
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14
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Kamaladasa DS, Sansom-Daly UM, Hetherington K, McGill BC, Ellis SJ, Kelada L, Donoghoe MW, Evans H, Anazodo A, Patterson P, Cohn RJ, Wakefield CE. How Are Families Faring? Perceived Family Functioning Among Adolescent and Young Adult Cancer Survivors in Comparison to Their Peers. J Adolesc Young Adult Oncol 2021; 10:711-719. [PMID: 33960837 DOI: 10.1089/jayao.2020.0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) cancer survivors' families can face ongoing challenges into survivorship. Families' adjustment and functioning as a unit can subsequently impact AYAs' mental health and quality of life. This study examined AYA cancer survivors' perceived family functioning, compared with their peers, and investigated factors associated with family functioning. Methods: Eligible participants were aged between 15 and 40 years, fluent in English, and cancer survivors who had completed treatment. AYA cancer survivors were recruited from hospital clinics, and the comparison group from an affiliated university campus. Participants completed the McMaster Family Assessment Device, Kidcope, and the Depression, Anxiety and Stress Scale-Short Form. We analyzed between-group differences in family functioning using multivariate analysis of covariance and used partial correlations to investigate associations between demographic cancer-related psychological coping variables and family functioning. Results: Ninety-three AYA cancer survivors and 141 comparison peers participated (ages: 15-32 years). AYA cancer survivors reported significantly better family functioning (p = 0.029), lower depression (p = 0.016), and anxiety symptoms (p = 0.008) compared with the comparison group. Approximately one-third of AYA survivors (34.4%) reported clinically significant maladaptive family functioning; however, this was more prevalent in the comparison group (50.4%). After adjusting for covariates, poorer family functioning was associated with AYA survivors using more avoidant escape-oriented coping strategies (p = 0.010). Conclusions: Our cancer survivor cohort reported better family functioning and psychological outcomes compared with their peers. Interventions targeting avoidant coping behaviors may support improved family functioning in some survivors. Further research disentangling the relationship between coping mechanisms and family functioning among AYA cancer survivors is needed.
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Affiliation(s)
- Dinuli S Kamaladasa
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M Sansom-Daly
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Kate Hetherington
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C McGill
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah J Ellis
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Lauren Kelada
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Mark W Donoghoe
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Kensington, Australia
| | - Holly Evans
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,School of Psychology, UNSW Sydney, Kensington, Australia
| | - Antoinette Anazodo
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Pandora Patterson
- Canteen Australia, Newtown, Australia.,Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Richard J Cohn
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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15
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Effect of Two Interventions on Sleep Quality for Adolescent and Young Adult Cancer Survivors: A Pilot Randomized Controlled Trial. Cancer Nurs 2021; 45:E560-E572. [PMID: 33883477 DOI: 10.1097/ncc.0000000000000932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sleep disturbance is common among adolescent and young adult (AYA) cancer survivors. Physical activity (PA) and behavioral activation (BA) therapy have been reported as enhancing sleep quality, but few studies exist on the effects of such interventions combined with technology to promote sleep quality in AYA cancer patients. OBJECTIVE The aim of this study was to investigate the feasibility and effects of intelligent wearable device-based PA therapy and internet-based modified BA therapy to improve sleep quality among AYA cancer patients. METHODS A randomized controlled trial with 143 AYA cancer patients was conducted. Participants were randomly assigned to a control group (n = 48), which performed routine care, a PA group (n = 47), which received 8-week PA therapy based on intelligent wearable devices, and a BA group (n = 48), which participated in internet-based modified BA therapy for 8 weeks. RESULTS At 1 week and 3 months after the intervention for sleep quality, there were statistically significant differences between the PA group and the control group (P = .020), but no statistically significant difference between the BA group and the control group. CONCLUSIONS The intelligent wearable device-based PA therapy has more advantages than internet-based modified BA therapy in improving the overall state of AYA cancer patients, and the intervention effect was sustained for at least 3 months. IMPLICATIONS FOR PRACTICE Developing and implementing PA plans for AYA cancer survivors can improve their sleep quality. Social media, intelligent wearable devices, and mobile health applications have unique advantages in promoting sleep quality for AYA cancer survivors.
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16
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Woodford J, Månberg J, Cajander Å, Enebrink P, Harila-Saari A, Hagström J, Karlsson M, Placid Solimena H, von Essen L. Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden. BMJ Open 2021; 11:e041350. [PMID: 34155002 PMCID: PMC8039225 DOI: 10.1136/bmjopen-2020-041350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support. E-mental health (e-MH) may offer a solution to reduce this treatment gap. However, research examining e-MH for AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to: (1) help-seeking behaviour and/or (2) e-MH acceptability. The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen's behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MH interventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking. METHODS AND ANALYSIS An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16-39 years, diagnosed with cancer when 0-18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-06271). Results will be disseminated in scientific publications and academic conference presentations. TRIAL REGISTRATION NUMBER ISRCTN70570236.
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Affiliation(s)
- Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jenny Månberg
- Child and Adolescent Psychiatry, Region Vasternorrland, Sundsvall, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Arja Harila-Saari
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mathilda Karlsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Placid Solimena
- International Maternal and Child Health Care, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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17
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Holland LR, Bradford NK, Youl P, Cossio D, Dunn N, Tran N, Walker R. Cancer Incidence, Mortality, and Survival for Children, Adolescents, and Young Adults in Queensland Between 1987 and 2016. J Adolesc Young Adult Oncol 2020; 10:629-644. [PMID: 33306001 DOI: 10.1089/jayao.2020.0151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Cancer remains the most common cause of disease-related death among young people and carries a significant burden. In the absence of prior state-based Australian epidemiological studies, this retrospective cohort study reviewed all cases of invasive cancer diagnosed in Queensland children, adolescents, and young adults (AYAs) (0-39 years) from 1987 to 2016 using the Queensland Oncology Repository (QOR). Methods: Cancers were classified according to Surveillance, Epidemiology and End Results (SEER) AYA site recode. Age-standardized rates (ASRs) were calculated. JoinPoint regression examined trends in ASRs across three age cohorts, for three decades (1987-1996, 1997-2006, and 2007-2016). Results: In total, 3,576 children aged 0-14 years (ASR = 15.2/100,000), 6,441 aged 15-24 years (ASR = 39.3/100,000), and 29,923 (ASR = 122.6/100,000) aged 25-39 years were diagnosed. Incidence increased for female children, and leukemia was the most common diagnosis. For those 15-24 years, incidence increased initially before decreasing and was higher than other nationally reported rates. For those 25-39 years, incidence increased. For the older cohorts, the most common diagnosis was melanoma. All cohorts demonstrated a decline in mortality and improvement in 5-year relative survival, with those 0-14 years demonstrating the greatest gains. The lowest survival for all cohorts was associated with central nervous system tumors. Conclusion: These results highlight areas in need of further investigation to improve survival, reduce the burden of cancer for young people, and aid service delivery. Future studies should focus on cancer biology, early detection, barriers in access to clinical trials, innovative models of care, improved data collection, and patient-reported outcomes.
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Affiliation(s)
- Lucy R Holland
- Institute of Health and BioMedical Innovation, Queensland University of Technology, Brisbane, Australia.,The University of Newcastle, Newcastle, Australia
| | - Natalie K Bradford
- Institute of Health and BioMedical Innovation at Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Danica Cossio
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Nathan Dunn
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Nancy Tran
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Rick Walker
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Princess Alexandra Hospital, Woolloongabba, Australia.,Queensland Youth Cancer Service, Children's Health Queensland, Brisbane, Australia.,Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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18
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Psychological Outcomes, Health-Related Quality of Life, and Neurocognitive Functioning in Survivors of Childhood Cancer and Their Parents. Pediatr Clin North Am 2020; 67:1103-1134. [PMID: 33131537 DOI: 10.1016/j.pcl.2020.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Childhood cancer disrupts the lives of patients and their families and affects acute and long-term psychological health. This article summarizes (1) psychological challenges, including depression, anxiety, worries, and posttraumatic stress, as well as positive outcomes such as benefit finding and posttraumatic growth in young survivors and parents; (2) health-related quality of life; (3) interventions to support survivors and parents with psychological difficulties; and (4) neurocognitive problems and interventions to help alleviate them. Although many survivors and parents fare well in the long term, many survivors may benefit from interventions. Interventions should be further evaluated and integrated into routine clinical care.
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19
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The Development and Process Evaluation of a 3-Day Acceptance and Commitment Therapy Group Program for Adolescent Cancer Survivors. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background
Adolescents diagnosed with cancer experience unique psychosocial concerns that persist beyond treatment completion into longer-term survivorship. Camp-based, group Acceptance and Commitment Therapy (ACT) programs are a potential model for providing evidence-informed psychological and peer support to adolescent cancer survivors.
Objective
This paper describes the development and exploration of the feasibility and acceptability of such a program, Places You’ll Go. This manualised program incorporates five 90-min group ACT sessions within a 3-day camp, teaching ACT strategies in the context of psychosocial impacts of cancer.
Method
Eight facilitators and twenty-eight Australian adolescent cancer survivors (68% female; age range 12–17 years, M = 15.4 years) participated in the program and evaluation. Feasibility was assessed using facilitator-reported session duration, attendance, quality and content fidelity; facilitators also completed interviews after program completion. Young people completed surveys on program acceptability at the end of each session and at program completion.
Results
All planned sessions were delivered, with 97% attendance and high fidelity in manualised program delivery. All young people were mostly or very satisfied and would recommend the program to another cancer survivor. Opportunities for peer connection and skill development contributed to perceived program acceptability.
Conclusions
The Places You’ll Go program was acceptable and feasible to deliver. It is a promising community-based model for promoting peer support and well-being in adolescent cancer survivors, indicating the potential of ACT-based approaches for this population. Further work is underway to evaluate whether the program improves psychosocial wellbeing among participants, and if this is linked to the therapeutic mechanisms underpinning ACT.
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20
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McDonnell GA, Pope AW, Ford JS. Associations Among Perceived Parent and Peer Support, Self-Esteem, and Cancer-Related Worry in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2020; 10:209-216. [PMID: 32833557 DOI: 10.1089/jayao.2020.0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Cancer-related worry is common among adolescent and young adult (AYA) cancer survivors, and is associated with adverse psychosocial outcomes. Thus, it is crucial to identify possible modifiable covariates of cancer-related worry to aid in developing targeted interventions. This study aimed to explore the cross-sectional associations between cancer-related worry and potential covariates (i.e., perceived parental support, perceived peer support, self-esteem). Methods: One hundred fifty-two survivors between the ages of 15 and 25 who had been diagnosed with cancer between the ages of 14 and 21 completed the Inventory of Parent and Peer Attachment, the Rosenberg Self-Esteem Scale, the Self-Perception Profile for Adolescents, and a measure of cancer-related worry. Relationships among variables were assessed through structural equation modeling. Results: The model showed good fit [χ2(13) = 13.26, p = 0.43; comparative fit index = 0.997; root mean square error of approximation = 0.01 (90% confidence interval = 0.00-0.08); standardized root mean square residual = 0.04]; however, not all associations were in expected directions. Higher perceived parent and peer support were each significantly associated with lower self-esteem, which, in turn, was significantly associated with higher cancer-related worry. There was no direct association between support variables and cancer-related worry. Conclusion: These findings, which contradict existing theory about self-esteem development in healthy AYAs and prior research about the association between support and self-esteem in children and adolescents with cancer, suggest complex, and likely reciprocal, relationships among perceived support, cancer-related worry, and self-esteem in AYA cancer survivors. Support interventions involving peers with cancer and cognitive behavioral interventions targeting parent and peer relationships, self-esteem, and cancer-related worry may be beneficial in fostering AYA cancer survivors' psychosocial development.
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Affiliation(s)
- Glynnis A McDonnell
- Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Alice W Pope
- Department of Psychology, St. John's University, Queens, New York, USA
| | - Jennifer S Ford
- Department of Psychology, Hunter College and The Graduate Center, City University of New York, New York, NY, USA
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21
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Trachtenberg L, Wong J, Rennie H, Esplen MJ. Translating the Restoring Body Image After Cancer (ReBIC) Group Therapy Intervention Into an Online Version: A Successful Case Study and Recommendations. Int J Group Psychother 2020; 70:307-328. [PMID: 38449219 DOI: 10.1080/00207284.2020.1751639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A growing number of face-to-face group therapy interventions are being translated into online versions in psycho-oncology. Yet few researchers have systematically described the complex translation process or systematic approaches used to maintain the integrity of the original empirically supported interventions. In this article, we present a case study to illustrate the process of translating an evidence-based face-to-face therapy group, Restoring Body Image after Cancer (ReBIC) into an online format. We highlight how three critical therapeutic components from the original intervention (guided imagery exercises, psychoeducational reading materials, and psychotherapeutic group processes) were maintained and translated for online delivery. We provide preliminary recommendations for future translation efforts of text-based online group therapies to encourage best practices.
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22
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West CH, Dusome DL, Winsor J, Rallison LB. Falling Down the Rabbit Hole: Child and Family Experiences of Pediatric Hematopoietic Stem Cell Transplant. QUALITATIVE HEALTH RESEARCH 2020; 30:1125-1138. [PMID: 32249699 PMCID: PMC7252601 DOI: 10.1177/1049732320912410] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pediatric hematopoietic stem cell transplant (HSCT) is an intensive treatment that can be life-threatening. All family members experience distress. We conducted a grounded theory study using a family systems-expressive arts framework to develop a theoretical understanding of the family experience of HSCT. Six families (15 family members) participated in two interviews, drew an image, and were guided through a "dialoguing with images" process. Participants did not always perceive HSCT as an experience they had lived as a family and were surprised to hear other family members' experiences. While one mother drew, she suddenly understood it was not only her ill child, but the entire family who had "fallen down the rabbit hole." The family experience of HSCT is described across (a) the pre-HSCT trajectory, (b) family fragmentation (hospitalization), and (c) family reintegration. We identified a critical need for targeted family intervention during the transition into HSCT, throughout and following hospitalization.
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Affiliation(s)
| | - Debra L. Dusome
- Brandon University (Winnipeg site), Winnipeg,
Manitoba, Canada
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23
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Mahadeo KM, Bajwa R, Abdel-Azim H, Lehmann LE, Duncan C, Zantek N, Vittorio J, Angelo J, McArthur J, Schadler K, Chan S, Tewari P, Khazal S, Auletta JJ, Choi SW, Shoberu B, Kalwak K, Harden A, Kebriaei P, Abe JI, Li S, Moffet JR, Abraham S, Tambaro FP, Kleinschmidt K, Richardson PG, Corbacioglu S. Diagnosis, grading, and treatment recommendations for children, adolescents, and young adults with sinusoidal obstructive syndrome: an international expert position statement. Lancet Haematol 2020; 7:e61-e72. [PMID: 31818728 DOI: 10.1016/s2352-3026(19)30201-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
Abstract
Sinusoidal obstructive syndrome, also known as hepatic veno-occlusive disease, is a potentially life-threatening complication that occurs in children undergoing haemopoietic stem-cell transplantation (HSCT). Differences in the incidence of genetic predisposition and clinical presentation of sinusoidal obstructive syndrome between children and adults have rendered the historical Baltimore and Seattle diagnostic criteria insufficient for children. In 2017, the European Society for Blood and Marrow Transplantation (EBMT) proposed the first paediatric diagnostic and severity grading guidelines for sinusoidal obstructive syndrome, intended for implementation across European centres. However, universally accepted paediatric criteria are needed to ensure prompt diagnosis, definitive treatment, and improved outcomes for children, adolescents, and young adults with sinusoidal obstructive syndrome, and to facilitate international clinical research collaboration. We convened an international panel of multidisciplinary experts including physicians with expertise in HSCT, paediatric intensive care, nephrology, hepatology, radiology, pathology, and transfusion medicine; HSCT advanced-practice providers and medical trainees; pharmacists; and translational and basic science researchers from the Pediatric Acute Lung Injury and Sepsis Investigators Network, the EBMT, the Pediatric Blood and Marrow Transplant Consortia, and several other institutions with extensive experience in sinusoidal obstructive syndrome. Panellists convened at The University of Texas, MD Anderson Cancer Center (Houston, TX, USA) in February, 2019, to evaluate the available evidence. In this expert position statement paper, we provide consensus recommendations for the international implementation of guidelines for the diagnosis, severity grading, and treatment of sinusoidal obstructive syndrome among children, adolescents, and young adults. We endorse universal adoption of paediatric diagnostic guidelines for sinusoidal obstruction syndrome as proposed by the EBMT, and provide implementation guidance for standardisation across centres; we have further proposed adjunctive use of age-appropriate organ-specific toxicity criteria for severity grading and provided prophylaxis and treatment considerations among children and adolescent and young adult patients. Key recommendations include: (1) liver biopsy, portal venous wedge pressure, and reversal of portal venous flow on Doppler ultrasonography should not be used for the routine diagnosis of sinusoidal obstructive syndrome in children, adolescents, and young adults; (2) platelet refractoriness can be defined as a corrected count increment of less than 5000-7500 following at least two sequential ABO-compatible fresh platelet transfusions; (3) hepatomegaly is best defined as an absolute increase of at least 1 cm in liver length at the midclavicular line; and if a baseline measurement is not available, hepatomegaly can be defined as greater than 2 SDs above normal for age; and (4) the presence and volume of ascites can be categorised as mild (minimal fluid by liver, spleen, or pelvis), moderate (<1 cm fluid), or severe (fluid in all three regions with >1 cm fluid in at least two regions).
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Affiliation(s)
- Kris M Mahadeo
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Rajinder Bajwa
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Blood and Marrow Transplantation Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Leslie E Lehmann
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Christine Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Nicole Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School. University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer Vittorio
- Department of Pediatrics, Division of Pediatric Transplant Hepatology, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Angelo
- Department of Pediatrics, Renal Division, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jennifer McArthur
- Department of Pediatrics, Division of Critical Care, St Jude's Children's Research Hospital, Memphis, TN, USA
| | - Keri Schadler
- Department of Pediatrics, Division of Pediatric Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherwin Chan
- Department of Radiology, Division of Pediatric Radiology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Priti Tewari
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sajad Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffery J Auletta
- Department of Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Sung Won Choi
- Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplant, University of Michigan, Ann Arbor, MI, USA
| | - Basirat Shoberu
- Department of Pharmacy, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Krzysztof Kalwak
- Department of Paediatrics, Division of Immunology and Transplantology, Medical University Wroclaw, Wroclaw, Poland
| | - Avis Harden
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jun-Ichi Abe
- Department of Cardiology, Division of Internal Medicine/Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shulin Li
- Department of Pediatrics, Division of Pediatric Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jerelyn Roberson Moffet
- Department of Pediatrics, Division of Blood and Marrow Transplant, Duke Children's Hospital, Duke University, Durham, NC, USA
| | - Susan Abraham
- Department of Pathology, Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Francesco Paolo Tambaro
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA; UOC SIT-TMO AORN Santobono-Pausilipon-Napoli, Italy
| | - Katharina Kleinschmidt
- Department of Pediatrics, Division of Pediatric Oncology, Stem Cell Transplant, University Hospital of Regensburg, Regensburg, Germany
| | - Paul G Richardson
- Department of Medical Oncology, Division of Hematologic Oncology, Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Selim Corbacioglu
- Department of Pediatrics, Division of Pediatric Oncology, Stem Cell Transplant, University Hospital of Regensburg, Regensburg, Germany
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24
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Baird H, Patterson P, Medlow S, Allison KR. Understanding and Improving Survivorship Care for Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:581-586. [PMID: 31268400 DOI: 10.1089/jayao.2019.0031] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: To explore and highlight the opportunities and challenges that underlie the development of survivorship care for adolescent and young adult cancer. Methods: A multimethod approach was used, with perspectives of survivors, relatives, and health care professionals elicited through an online survey, focus group, and semistructured interviews. Results: Four themes were identified using thematic analysis: adjusting to life after cancer, transition to community-based care, ongoing change and reform of health care, and supporting survivorship services. Adolescents and young adults (AYAs) and their families struggled with the transition from active treatment, which was complicated by ongoing disease/treatment impacts and a collective dearth of knowledge and resources on how to support AYAs during this time. Limited confidence and communication in patient-general practitioner relationships complicated the transition to community-based care, with treatment summaries and survivorship care plans an underused resource. A growing movement toward integrated, holistic, and equitable survivorship care was identified, but progress has been fragmented and under-resourced. Further research, funding, and advocacy are needed to support ongoing survivorship initiatives. Conclusions: Although some survivorship concerns are common across age groups, others are specific to AYAs' developmental stage, emphasizing the need for integrated, age-appropriate, and targeted survivorship services for AYAs. The transition from active treatment to longer term survivorship presents challenges for ongoing clinical care and support; change is needed at individual, service, and system levels to provide quality, sustainable, and integrated care to AYA cancer survivors.
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Affiliation(s)
- Hannah Baird
- Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia
| | - Pandora Patterson
- Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia.,Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
| | - Sharon Medlow
- Wellbeing Health & Youth, Centre of Research Excellence in Adolescent Health, The University of Sydney, Sydney, Australia.,Discipline of Child & Adolescent Health, The Children's Hospital at Westmead, Sydney, Australia
| | - Kimberley R Allison
- Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia
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25
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Brierley ME, Sansom‐Daly UM, Baenziger J, McGill B, Wakefield CE. Impact of physical appearance changes reported by adolescent and young adult cancer survivors: A qualitative analysis. Eur J Cancer Care (Engl) 2019; 28:e13052. [DOI: 10.1111/ecc.13052] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/31/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mary‐Ellen E. Brierley
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health UNSW Sydney Kensington New South Wales Australia
| | - Ursula M. Sansom‐Daly
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health UNSW Sydney Kensington New South Wales Australia
| | - Julia Baenziger
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health UNSW Sydney Kensington New South Wales Australia
- Department of Health Sciences & Health Policy University of Lucerne Lucerne Switzerland
| | - Brittany McGill
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health UNSW Sydney Kensington New South Wales Australia
| | - Claire E. Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health UNSW Sydney Kensington New South Wales Australia
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26
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Aubin S, Rosberger Z, Hafez N, Noory MR, Perez S, Lehmann S, Batist G, Kavan P. Cancer!? I Don't Have Time for That: Impact of a Psychosocial Intervention for Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:172-189. [DOI: 10.1089/jayao.2017.0101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - Nada Hafez
- Jewish General Hospital, Montreal, Canada
| | | | | | | | | | - Petr Kavan
- Jewish General Hospital, Montreal, Canada
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27
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LaRosa KN, Stern M, Lynn C, Hudson J, Reed DR, Donovan KA, Quinn GP. Provider perceptions' of a patient navigator for adolescents and young adults with cancer. Support Care Cancer 2019; 27:4091-4098. [PMID: 30778757 DOI: 10.1007/s00520-019-04687-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Healthcare providers (HCPs) and other staff at a comprehensive Cancer Center were interviewed on how to best implement a patient navigator position when working with adolescents and young adults (AYA) with cancer. Research objectives included assessing staff perceptions of (a) barriers to optimal care for AYA, (b) roles and responsibilities for a patient navigator, and (c) training needed for future patient navigators. METHODS Semi-structured interviews were conducted with 17 staff members providing care to AYA. Verbatim transcripts were hand-coded using inductive content analysis. RESULTS Roles and responsibilities of a patient navigator were described as needing to coordinate services, be knowledgeable of resources inside and outside the Cancer Center, provide emotional support, advocate for AYA, assist with financial and insurance issues, and serving as the first point of contact. CONCLUSIONS Staff serving AYA reported the desired roles and training they wished a patient navigator to possess. This study contributes to the literature by conducting stakeholder assessment of the goals and roles of an AYA patient navigator (PN). PN positions should be adapted to the workflow and ethos of the institution.
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Affiliation(s)
- Kayla N LaRosa
- Department of Educational and Psychology Studies, University of South Florida, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Marilyn Stern
- University of South Florida, Tampa, FL, USA. .,Department of Child and Family Studies, University of South Florida, Tampa, FL, USA. .,Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA. .,Adolescent and Young Adult Program, Moffitt Cancer Center, Tampa, FL, USA. .,, Tampa, FL, USA.
| | - Courtney Lynn
- Department of Educational and Psychology Studies, University of South Florida, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Janella Hudson
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Damon R Reed
- Adolescent and Young Adult Program, Moffitt Cancer Center, Tampa, FL, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA.,Sarcoma Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Kristine A Donovan
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA.,Adolescent and Young Adult Program, Moffitt Cancer Center, Tampa, FL, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Gwendolyn P Quinn
- Department of OB-GYN, School of Medicine, New York University, New York, NY, 10016, USA.,Department of Population Health, School of Medicine, New York University, New York, NY, 10016, USA.,Center for Medical Ethics, New York University, New York, NY, 10016, USA
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28
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Anthony SJ, Robertson T, Selkirk E, Dix D, Klaassen RJ, Sung L, Klassen AF. The social impact of early psychological maturity in adolescents with cancer. Psychooncology 2019; 28:586-592. [PMID: 30646430 DOI: 10.1002/pon.4982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 01/01/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE There is a growing need to assess the long-term quality of life (QOL) of pediatric oncology patients since many children now survive their disease. This paper highlights the subjective perspectives of pediatric cancer patients and specifically explores how experiencing cancer at a young age impacts adolescents in the areas of social functioning, peer relationships, and QOL. The findings emerged from a qualitative research study that explored how pediatric oncology patients ascribe meaning to their illness. METHODS Study participants were recruited from four Canadian academic pediatric hospitals. In this study, we used an interpretative description approach. Semistructured interviews were completed, transcribed verbatim, and coded through the method of constant comparison. RESULTS A total of 37 children and adolescents (n = 19 female; 51%) participated. The majority of participants were diagnosed with leukemia (n = 16; 43%) or lymphoma (n = 9; 24%). Sixty-two percent of participants were adolescents between the ages of 13 and 18 years (n = 23). Data illustrated a unique adolescent experience, which has been reported as a subset of the original population. Adolescent participants noted an accelerated experience of maturation, which invited reflections of gratitude as well as feelings of isolation and disconnect from peers. Participants were saddened to have "missed out" on normative parts of childhood. CONCLUSION Findings highlighted experiences of accelerated maturity that prompted adverse social outcomes for adolescent participants, which impacted their QOL. Future research is needed to explore the intersection of accelerated maturity attributed to illness, social functioning, and QOL. Peer support through technology engagement is suggested for this population.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children/Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Taylor Robertson
- Child Health Evaluative Sciences, The Hospital for Sick Children/Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada
| | - Enid Selkirk
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - David Dix
- Department of Pediatrics Hem/Onc/BMT, BC Children's Hospital, Vancouver, BC, Canada
| | - Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lillian Sung
- Division of Haematology-Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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29
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Sansom‐Daly UM, Wakefield CE, Bryant RA, Patterson P, Anazodo A, Butow P, Sawyer SM, McGill BC, Evans HE, Cohn RJ. Feasibility, acceptability, and safety of the Recapture Life videoconferencing intervention for adolescent and young adult cancer survivors. Psychooncology 2018; 28:284-292. [DOI: 10.1002/pon.4938] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/05/2018] [Accepted: 11/04/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Ursula M. Sansom‐Daly
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
- Nelune Comprehensive Cancer CentrePrince of Wales Hospital Sydney Australia
| | - Claire E. Wakefield
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | | | - Pandora Patterson
- Research, Evaluation and Social Policy UnitCanTeen Newtown Australia
- Cancer Nursing Research Unit, Sydney Nursing SchoolThe University of Sydney Sydney Australia
| | - Antoinette Anazodo
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
- Nelune Comprehensive Cancer CentrePrince of Wales Hospital Sydney Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), School of PsychologyUniversity of Sydney Sydney Australia
| | - Susan M. Sawyer
- Department of PaediatricsUniversity of Melbourne Melbourne Australia
- Murdoch Children's Research Institute Melbourne Australia
- Royal Children's Hospital Centre for Adolescent Health Melbourne Australia
| | - Brittany C. McGill
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | - Holly E. Evans
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
| | - Richard J. Cohn
- School of Women's and Children's HealthUNSW Sydney Sydney Australia
- Behavioural Sciences Unit, Kids Cancer CentreSydney Children's Hospital Sydney Australia
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30
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31
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Kelada L, Wakefield CE, Doolan EL, Drew D, Wiener L, Michel G, Cohn RJ. Grandparents of children with cancer: a controlled comparison of perceived family functioning. Support Care Cancer 2018; 27:2087-2094. [PMID: 30229340 DOI: 10.1007/s00520-018-4468-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/10/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Grandparents can be profoundly emotionally affected when a grandchild is diagnosed with cancer. They also often provide invaluable support for the family (e.g., caring for the sick child and/or siblings). Multigenerational family functioning may therefore change. Limited research has assessed grandparents' perspectives after their grandchild is diagnosed with cancer. In this study, we aimed to (1) assess differences in perceived family functioning among grandparents of a child with cancer and grandparents of healthy children and (2) assess the cancer-specific and demographic factors related to perceived family functioning in grandparents of a grandchild with cancer. PROCEDURE Grandparents of a child with cancer (n = 89) and grandparents of healthy children (n = 133) completed the general functioning, communication, and problem-solving scales of the Family Assessment Device. We used multilevel models with a random intercept to detect (1) between-group differences and (2) identify factors related to perceived family functioning among grandparents with a grandchild with cancer. RESULTS Grandparents with a grandchild with cancer reported poorer family functioning than grandparents with healthy grandchildren. Among the grandparents with a grandchild with cancer, impairments in family functioning were correlated with fewer years since diagnosis, providing care to their sick grandchild and/or siblings and living far away from the sick grandchild. CONCLUSIONS The detrimental impact of childhood cancer likely extends beyond the immediate family members. Including grandparents in interventions-beginning at diagnosis-to reduce distress and increase cohesion for families of a child with cancer is warranted, particularly for grandparents who provide care to their sick grandchild or siblings.
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Affiliation(s)
- Lauren Kelada
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia. .,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia.
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - E L Doolan
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - D Drew
- Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - L Wiener
- Behavioral Health Core, National Cancer Institute, Bethesda, MD, 20892, USA
| | - G Michel
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - R J Cohn
- School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, 2031, Australia.,Kids Cancer Centre, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
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32
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Chalmers JA, Sansom-Daly UM, Patterson P, McCowage G, Anazodo A. Psychosocial Assessment Using Telehealth in Adolescents and Young Adults With Cancer: A Partially Randomized Patient Preference Pilot Study. JMIR Res Protoc 2018; 7:e168. [PMID: 30158103 PMCID: PMC6135966 DOI: 10.2196/resprot.8886] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/05/2018] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescent and young adults with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of inpatient face-to-face psychosocial care might limit the capacity for clinicians to provide timely and personalized assessment and intervention for this group. Telehealth offers a promising alternative toward increasing access to the provision of evidence-based psychosocial assessment and treatment for adolescent and young adults with cancer. OBJECTIVE This pilot study aimed to assess the feasibility and acceptability for both patients and clinicians of providing a psychosocial assessment via telehealth to adolescents and young adults currently receiving treatment for cancer, relative to face-to-face delivery. METHODS We included patients who were aged 15-25 years, currently receiving treatment, could speak English well, and medically stable. Patients were recruited from oncology clinics or wards from 5 hospitals located across Sydney and Canberra, Australia, and allocated them to receive psychosocial assessment (Adolescent and Young Adult Oncology Psychosocial Assessment Measure) with a clinical psychologist or social worker through face-to-face or telehealth modalities using a partially randomized patient preference model. Patients completed a pre- and postassessment questionnaire comprising validated and purposely designed feasibility and acceptability indices, including the impact of technical difficulties, if patients had their own devices; number of patients who were content with their group allocation; self-reported preference of modality; Treatment Credibility and Expectations Questionnaire; and Working Alliance Inventory. Clinicians also completed a postassessment questionnaire rating their impressions of the acceptability and feasibility of intervention delivery by each modality. RESULTS Of 29 patients approached, 23 consented to participate (response rate: 79%). Participants were partially randomized to either telehealth (8/23, 35%; mean age 16.50 years, range 15-23 years; females: 4/8, 50%) or face-to-face (11/23, 62%; mean age 17 years, range 15-22 years; females: 8/11, 72%) conditions. Four participants withdrew consent because of logistical or medical complications (attrition rate: 17.4%). Most participants (6/8, 75%) in the telehealth group used their computer or iPad (2 were provided with an iPad), with minor technical difficulties occurring in 3 of 8 (37.5%) assessments. Participants in both groups rated high working alliance (Working Alliance Inventory; median patient response in the telehealth group, 74, range 59-84 and face-to-face group, 63, range 51-84) and reported positive beliefs regarding the credibility and expectations of their treatment group. Postassessment preferences between face-to-face or telehealth modalities varied. Most patients in the telehealth group (5/8, 63%) reported no preference, whereas 6 of 11 (55%) in the face-to-face group reported a preference for the face-to-face modality. CONCLUSIONS Telehealth is acceptable as patient comfort was comparable across modalities, with no significant technological barriers experienced. However, patients varied in their preferred interview modality, highlighting the need to tailor the treatment to patient preference and circumstances. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001142628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366609 (Archived by WebCite at http://www.webcitation.org/721889HpE).
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Affiliation(s)
| | - Ursula Margaret Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.,Sydney Youth Cancer Service, Prince of Wales Hospitals, Randwick, Australia
| | - Pandora Patterson
- Department of Research, Evaluation & Social Policy, CanTeen Australia, Newtown, Australia.,Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - Geoffrey McCowage
- Cancer Centre for Children, Children's Hospital at Westmead, Westmead, Australia
| | - Antoinette Anazodo
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospitals, Randwick, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
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Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN. E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions. Cochrane Database Syst Rev 2018; 8:CD012489. [PMID: 30110718 PMCID: PMC6513202 DOI: 10.1002/14651858.cd012489.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. Access to face-to-face treatment for such problems is often limited, and available interventions usually have not been tested with this population. As technology improves, e-health interventions (delivered via digital means, such as computers and smart phones and ranging from simple text-based programmes through to multimedia and interactive programmes, serious games, virtual reality and biofeedback programmes) offer a potential solution to address the psychological needs of this group of young people. OBJECTIVES To assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDTR to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2017), Web of Science (1900 - 18 August 2016, updated 31 August 2017) and Ovid MEDLINE, Embase, PsycINFO (cross-search 2016 to 18 Aug 2017). We hand-searched relevant conference proceedings, reference lists of included articles, and the grey literature to May 2016. We also searched international trial registries to identify unpublished or ongoing trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised trials, and cross-over trials of e-health interventions for treating any type of long-term physical condition in children and adolescents (aged 0 to 18 years), and that measured changes in symptoms or diagnoses of anxiety, depression, or subthreshold depression. We defined long-term physical conditions as those that were more than three-months' duration. We assessed symptoms of anxiety and depression using patient- or clinician-administered validated rating scales based on DSM III, IV or 5 (American Psychological Association 2013), or ICD 9 or 10 criteria (World Health Organization 1992). Formal depressive and anxiety disorders were diagnosed using structured clinical interviews. Attention placebo, treatment as usual, waiting list, psychological placebo, and other non-psychological therapies were eligible comparators. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed titles, abstracts, and full-text articles; discrepancies were resolved through discussion or addressed by a third author. When available, we used odds ratio (OR) to compare dichotomous data and standardised mean differences (SMD) to analyse continuous data, both with 95% confidence intervals (CI). We undertook meta-analysis when treatments, participants, and the underlying clinical question were adequately similar. Otherwise, we undertook a narrative analysis. MAIN RESULTS We included five trials of three interventions (Breathe Easier Online, Web-MAP, and multimodal cognitive behavioural therapy (CBT)), which included 463 participants aged 10 to 18 years. Each trial contributed to at least one meta-analysis. Trials involved children and adolescents with long-term physical conditions, such as chronic headache (migraine, tension headache, and others), chronic pain conditions (abdominal, musculoskeletal, and others), chronic respiratory illness (asthma, cystic fibrosis, and others), and symptoms of anxiety or depression. Participants were recruited from community settings and hospital clinics in high income countries.For the primary outcome of change in depression symptoms versus any control, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.06, 95% CI -0.35 to 0.23; five RCTs, 441 participants). For the primary outcome of change in anxiety symptoms versus any comparator, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.07, 95% CI -0.29 to 0.14; two RCTs, 324 participants). For the primary outcome of treatment acceptability, there was very low-quality evidence that e-health interventions were less acceptable than any comparator (SMD 0.46, 95% CI 0.23 to 0.69; two RCTs, 304 participants).For the secondary outcome of quality of life, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.83, 95% CI -1.53 to -0.12; one RCT, 34 participants). For the secondary outcome of functioning, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.08, 95% CI -0.33 to 0.18; three RCTs, 368 participants). For the secondary outcome of status of long-term physical condition, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD 0.06, 95% CI -0.12 to 0.24; five RCTs, 463 participants).The risk of selection bias was considered low in most trials. However, the risk of bias due to inadequate blinding of participants or outcome assessors was considered unclear or high in all trials. Only one study had a published protocol; two trials had incomplete outcome data. All trials were conducted by the intervention developers, introducing another possible bias. No adverse effects were reported by any authors. AUTHORS' CONCLUSIONS At present, the field of e-health interventions for the treatment of anxiety or depression in children and adolescents with long-term physical conditions is limited to five low quality trials. The very low-quality of the evidence means the effects of e-health interventions are uncertain at this time, especially in children aged under 10 years.Although it is too early to recommend e-health interventions for this clinical population, given their growing number, and the global improvement in access to technology, there appears to be room for the development and evaluation of acceptable and effective technologically-based treatments to suit children and adolescents with long-term physical conditions.
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Affiliation(s)
- Hiran Thabrew
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Karolina Stasiak
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | - Stephen Wong
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
| | - Jessica H Huss
- University of KasselDepartment of PsychologyKasselGermany
| | - Sally N Merry
- University of AucklandDepartment of Psychological MedicineLevel 12 Support BuildingAuckland Hospital, Park Road, GraftonAucklandNew Zealand
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Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies. Blood 2018; 132:385-392. [DOI: 10.1182/blood-2017-11-778555] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/05/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
Adolescents and young adults (AYAs) occupy a unique place within the hematologic malignancy community due to the challenges they face related to their disease biology and physical, psychosocial, and economic circumstances, as well as issues related to access to care and long-term follow-up. Efforts to define age-specific (supportive) care needs and targets for intervention in these areas are evolving. This review discusses the psychosocial issues AYAs with hematologic malignancies are dealing with, how these might affect their health-related quality of life, and the challenges in delivering high-quality supportive care to this underserved population.
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Satapathy S, Kaushal T, Bakhshi S, Chadda RK. Non-pharmacological Interventions for Pediatric Cancer Patients: A Comparative Review and Emerging Needs in India. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1323-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Evon DM, Golin CE, Ruffin R, Ayres S, Fried MW. Novel patient-reported outcomes (PROs) used in a pilot and feasibility study of a Cognitive Behavioral Coping Skills (CBCS) group intervention for patients with chronic hepatitis C. Pilot Feasibility Stud 2018; 4:92. [PMID: 29983993 PMCID: PMC6020443 DOI: 10.1186/s40814-018-0285-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/02/2018] [Indexed: 02/06/2023] Open
Abstract
Background Patients with chronic hepatitis C virus (HCV) experience reduced quality of life, HCV-associated symptoms, comorbid conditions, and treatment side effects. The Cognitive Behavioral Coping Skills group intervention for HCV (CBCS-HCV) was developed using the Stage Model of Behavioral Therapies Research. Intervention development and initial feasibility testing in wave 1 participants were previously reported. The primary objective of this subsequent pilot with wave 2–3 participants was to investigate the effect sizes and clinical improvements in patient-reported outcomes (PROs) and trial and intervention feasibility. Methods A pilot feasibility two-arm randomized controlled trial using block randomization to assign patients to CBCS-HCV or standard of care was conducted. Participants attended nine group sessions: four before HCV treatment and five during treatment. PRO data were collected at five time points: before the CBCS intervention (T1), immediately before HCV treatment (T2), during HCV treatment (T3, T4), and 1 month post-intervention/post-HCV treatment (T5). PROs included quality of life, perceived stress, HCV symptoms, and medication adherence. Cohen’s d was used to estimate within-group changes (WGCs) and between-group differences (BGDs), with d > 0.35 considered potentially clinically significant. Potential mechanisms of change were also evaluated. Results Several WGCs and BGDs (ES > .35) suggest that the CBCS-HCV may promote improvements in PROs: psychological stress, depression, anger, anxiety, sleep disturbance, and fatigue. The intervention did not appear to impact social functioning, pain, or medication adherence. Cognitive behavioral skills and group therapy dynamics, but not HCV treatment self-efficacy, may mediate improvements in PROs. Most aspects of the study trial, including intervention implementation, were feasible. Patient acceptance and retention were exceptional. The greatest feasibility challenge was due to patients needing to initiate treatment as soon as medications were obtained, but often before a full block could be created in wave 3. Challenges with PRO data collection were identified that will be resolved in future studies. Conclusions The CBCS-HCV intervention warrants future investigation in an efficacy trial to evaluate improvements in selected PROs. The next step is to pilot test the CBCS-HCV delivered via telehealth to an expanded pool of patients to reduce patient barriers, hone technical logistics, and improve intervention reach and effectiveness. Trial registration NCT03057236 Retrospectively registered.
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Affiliation(s)
- Donna M Evon
- 1Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC 27599 USA
| | - Carol E Golin
- 2Department of Medicine, University of North Carolina, Chapel Hill, NC USA.,3Department of Health Behavior, University of North Carolina, Chapel Hill, NC USA
| | | | - Shauna Ayres
- 3Department of Health Behavior, University of North Carolina, Chapel Hill, NC USA
| | - Michael W Fried
- 1Division of Gastroenterology and Hepatology, University of North Carolina, CB# 7584, 8010 Burnett-Womack, Chapel Hill, NC 27599 USA
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Tonorezos ES, Barnea D, Cohn RJ, Cypriano MS, Fresneau BC, Haupt R, Hjorth L, Ishida Y, Kruseova J, Kuehni CE, Kurkure PA, Langer T, Nathan PC, Skeen JE, Skinner R, Tacyildiz N, van den Heuvel-Eibrink MM, Winther JF, Hudson MM, Oeffinger KC. Models of Care for Survivors of Childhood Cancer From Across the Globe: Advancing Survivorship Care in the Next Decade. J Clin Oncol 2018; 36:2223-2230. [PMID: 29874138 DOI: 10.1200/jco.2017.76.5180] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
With improvements in cancer treatment and supportive care, a growing population of survivors of childhood cancer at risk for significant and potentially life-threatening late effects has been identified. To provide a current snapshot of the models of care from countries with varying levels of resources and health care systems, stakeholders in childhood cancer survivorship clinical care and research were identified from 18 countries across five continents. Stakeholders responded to a survey and provided a brief narrative regarding the current state of survivorship care. Findings indicate that among pediatric-age survivors of childhood cancer (allowing for differences in age cutoffs across countries), resources are generally available, and a large proportion of survivors are seen by a physician familiar with late effects in most countries. After survivors transition to adulthood, only a minority are seen by a physician familiar with late effects. Despite the need to improve communication between pediatric oncology and primary care, only a few countries have existing national efforts to educate primary care physicians, although many more reported that educational programs are in development. These data highlight common challenges and potential solutions for the lifelong care of survivors of childhood cancer. Combining risk-based and patient-oriented solutions for this population is likely to benefit both providers and patients.
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Affiliation(s)
- Emily S Tonorezos
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Dana Barnea
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Richard J Cohn
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Monica S Cypriano
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Brice C Fresneau
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Riccardo Haupt
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Lars Hjorth
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Yasushi Ishida
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Jarmila Kruseova
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Claudia E Kuehni
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Purna A Kurkure
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Thorsten Langer
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Paul C Nathan
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Jane E Skeen
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Roderick Skinner
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Nurdan Tacyildiz
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Marry M van den Heuvel-Eibrink
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Jeanette F Winther
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Melissa M Hudson
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
| | - Kevin C Oeffinger
- Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center, New York, NY; Dana Barnea, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Richard J. Cohn, Sydney Children's Hospital, and University of New South Wales Medicine, Sydney, New South Wales, Australia; Monica S. Cypriano, Grupo de Apoio ao Adolescente e Criança com Câncer (GRAACC)/Universidade Federal de São Paulo, São Paulo, Brazil; Brice C. Fresneau, Gustave Roussy, Université Paris-Saclay, Paris-Sud University, Centre for Research in Epidemiology and Population Health (CESP), and L'Institut National de la Santé et de la Recherche Médicale, Villejuif, France; Riccardo Haupt, Istituto Giannina Gaslini, Genoa, Italy; Lars Hjorth, Lund University, Skane University Hospital, Lund, Sweden; Yasushi Ishida, Ehime Prefectural Central Hospital, Matsuyama, Japan; Jarmila Kruseova, Charles University, Prague, Czech Republic; Claudia E. Kuehni, University of Bern, Bern, Switzerland; Purna A. Kurkure, Society for Rehabilitation of Crippled Children (SRCC) Children's Hospital, Indian Cancer Society, and Tata Memorial Hospital, Mumbai, India; Thorsten Langer, University Hospital, Luebeck, Germany; Paul C. Nathan, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada; Jane E. Skeen, Starship Children's Hospital, Auckland, New Zealand; Roderick Skinner, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, and Newcastle University, Newcastle upon Tyne, United Kingdom; Nurdan Tacyildiz, Ankara University School of Medicine, Ankara, Turkey; Marry M. van den Heuvel-Eibrink, Princess Máxima Center, Utrecht, and Dutch Childhood Oncology Group Long-Term Effects After Childhood Cancer (LATER) Group, The Hague, the Netherlands; Jeanette F. Winther, Danish Cancer Society Research Center, Copenhagen, and Aarhus University, Aarhus, Denmark; Melissa M. Hudson, St Jude Children's Research Hospital, Memphis, TN; and Kevin C. Oeffinger, Duke University, Durham, NC
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Touyz L, Cohen J, Wakefield C, Grech A, Garnett S, Gohil P, Cohn R. Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study. JMIR Res Protoc 2018; 7:e129. [PMID: 29769170 PMCID: PMC5976864 DOI: 10.2196/resprot.9252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Poor dietary habits are common among childhood cancer survivors, despite increasing their risk of cardio metabolic complications after cancer treatment. Here, we describe the design and rationale for a pilot telephone-based, parent-led intervention aimed at increasing fruit and vegetable intake in young cancer survivors (Reboot). OBJECTIVE This pilot study aims to assess the feasibility and acceptability of delivering evidence-based telephone support to parents of childhood cancer survivors. A secondary aim includes assessing the effect of Reboot on improving childhood cancer survivors' dietary quality by increasing child fruit and vegetable intake and variety and its contribution to overall nutrient intake. METHODS We aim to recruit parents of 15 young cancer survivors aged 2 to 12 years who have completed cancer treatment less than five years ago. The intervention comprises of 4 weekly 45-minute telephone sessions led by a health professional and one booster session 6 weeks later. Sessions address the effects of cancer treatment on children's diets, recommended fruit and vegetable intake for children, and evidence-based strategies to promote the consumption of fruit and vegetables as well as to manage fussy eating. RESULTS Reboot is based on an existing, evidence-based parent nutrition intervention and modified for childhood cancer survivors following extensive collaboration with experts in the field. Primary outcomes of feasibility and acceptability will be measured by the number of participants who complete all five sessions, average session length (minutes), length between sessions (days) and parent Likert ratings of the usefulness and impact of the intervention collected after the booster session. Of the 15 participants we aim to recruit, 3 have completed the intervention, 1 declined to participate, 11 are actively completing the intervention and 2 participants are providing written consent. The remaining 3 participants will be recruited via telephone follow-up calls. The intervention is due to be completed by July 2018. CONCLUSIONS Reboot aims to support healthy dietary behaviors in childhood cancer survivors who are at increased risk of developing serious cardiometabolic complications after their cancer treatment. Results will inform the development and implementation of future evidence-based dietary interventions delivered to childhood cancer survivors, particularly those living in rural and remote areas. REGISTERED REPORT IDENTIFIER RR1-10.2196/9252.
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Affiliation(s)
- Lauren Touyz
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Jennifer Cohen
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Claire Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Allison Grech
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Sarah Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Paayal Gohil
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Children's Health, University of New South Wales Sydney, Sydney, Australia
| | - Richard Cohn
- Behavioural Sciences Unit, Kids Cancer Centre, School of Women's and Chidlren's Health, University of New South Wales Sydney, Sydney, Australia
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Viola A, Taggi-Pinto A, Sahler OJZ, Alderfer MA, Devine KA. Problem-solving skills, parent-adolescent communication, dyadic functioning, and distress among adolescents with cancer. Pediatr Blood Cancer 2018; 65:e26951. [PMID: 29316232 PMCID: PMC5867217 DOI: 10.1002/pbc.26951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 12/20/2022]
Abstract
Some adolescents with cancer report distress and unmet needs. Guided by the disability-stress-coping model, we evaluated associations among problem-solving skills, parent-adolescent cancer-related communication, parent-adolescent dyadic functioning, and distress in adolescents with cancer. Thirty-nine adolescent-parent dyads completed measures of these constructs. Adolescents were 14-20 years old on treatment or within 1 year of completing treatment. Better problem-solving skills were correlated with lower adolescent distress (r = -0.70, P < 0.001). Adolescent-reported cancer-related communication problems and dyadic functioning were not significantly related to adolescent distress (rs < 0.18). Future work should examine use of problem-solving interventions to decrease distress for adolescents with cancer.
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Affiliation(s)
- Adrienne Viola
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Melissa A. Alderfer
- Nemours Children’s Health System, Wilmington, Delaware,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Sansom-Daly UM, Evans HE, Ellis SJ, McGill BC, Hetherington K, Wakefield CE. Something's got to give: time-cost trade-offs in site-specific research approval can negatively impact patient recruitment in multi-institutional studies. Intern Med J 2017; 47:1088-1089. [PMID: 28891181 DOI: 10.1111/imj.13535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Ursula M Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Holly E Evans
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Sarah J Ellis
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Brittany C McGill
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Kate Hetherington
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Vetsch J, Wakefield CE, McGill BC, Cohn RJ, Ellis SJ, Stefanic N, Sawyer SM, Zebrack B, Sansom-Daly UM. Educational and vocational goal disruption in adolescent and young adult cancer survivors. Psychooncology 2017; 27:532-538. [DOI: 10.1002/pon.4525] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Janine Vetsch
- Department of Health Sciences and Health Policy; University of Lucerne; Lucerne Switzerland
- School of Women's and Children's Health, UNSW Sydney; NSW Australia
- Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, UNSW Sydney; NSW Australia
- Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
| | - Brittany C. McGill
- School of Women's and Children's Health, UNSW Sydney; NSW Australia
- Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
| | - Richard J. Cohn
- School of Women's and Children's Health, UNSW Sydney; NSW Australia
- Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
| | - Sarah J. Ellis
- School of Women's and Children's Health, UNSW Sydney; NSW Australia
- Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
| | - Natalie Stefanic
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Camperdown NSW Australia
| | - Susan M. Sawyer
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Centre for Adolescent Health; Royal Children's Hospital; Parkville VIC Australia
- Murdoch Children's Research Institute; Parkville VIC Australia
| | - Brad Zebrack
- School of Social Work; University of Michigan; Ann Arbor MI USA
| | - Ursula M. Sansom-Daly
- School of Women's and Children's Health, UNSW Sydney; NSW Australia
- Kids Cancer Centre; Sydney Children's Hospital; Randwick NSW Australia
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May EA, McGill BC, Robertson EG, Anazodo A, Wakefield CE, Sansom-Daly UM. Adolescent and Young Adult Cancer Survivors' Experiences of the Healthcare System: A Qualitative Study. J Adolesc Young Adult Oncol 2017; 7:88-96. [PMID: 28737997 DOI: 10.1089/jayao.2017.0015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To qualitatively examine the experiences of diagnosis and treatment, and attitudes toward ongoing healthcare of adolescent and young adult (AYA) survivors of AYA cancer, to determine barriers to healthcare engagement in the early survivorship period. METHODS Forty-two participants aged between 15 and 25 years were recruited between February 2013 and October 2015 as part of a larger Australia-wide study. This study analyzed data collected through a semistructured telephone interview. Interviews were recorded and transcribed verbatim and then coded line-by-line. Data were analyzed for emergent themes using the qualitative software NVivo. RESULTS Many participants demonstrated a good understanding of their cancer diagnosis and treatment. Participants expressed high levels of confidence in their healthcare teams and demonstrated a conscientious approach to their ongoing cancer-specific and general healthcare. However, most AYAs had expectations of the cancer journey that differed from the realities of their experiences. CONCLUSIONS The results further highlight the crucial role of healthcare professionals in ensuring AYA cancer patients have accurate expectations of diagnosis and treatment, and develop a strong working knowledge of their disease that is maintained into survivorship. AYA cancer survivors may require ongoing education and support to stay engaged with long-term follow-up care.
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Affiliation(s)
- Elizabeth A May
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia .,2 Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia
| | - Brittany C McGill
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia .,2 Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia
| | - Eden G Robertson
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia .,2 Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia
| | - Antoinette Anazodo
- 3 Sydney Youth Cancer Service, Sydney Children's and Prince of Wales Hospitals , Sydney, New South Wales, Australia
| | - Claire E Wakefield
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia .,2 Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia
| | - Ursula M Sansom-Daly
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, New South Wales, Australia .,2 Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia .,3 Sydney Youth Cancer Service, Sydney Children's and Prince of Wales Hospitals , Sydney, New South Wales, Australia
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McGill BC, Sansom-Daly UM, Wakefield CE, Ellis SJ, Robertson EG, Cohn RJ. Therapeutic Alliance and Group Cohesion in an Online Support Program for Adolescent and Young Adult Cancer Survivors: Lessons from "Recapture Life". J Adolesc Young Adult Oncol 2017; 6:568-572. [PMID: 28581346 DOI: 10.1089/jayao.2017.0001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Psychological support services for adolescent and young adults (AYAs) with cancer are moving online and are increasingly peer based. It is unclear whether online service delivery impacts critical therapeutic elements such as collaborative patient-therapist rapport and group cohesion. AYA cancer survivors (N = 39) participating in a six-week online cognitive-behavioral therapy group program-"Recapture Life"-rated their perception of therapeutic alliance and group cohesion. Participant-rated alliance and group cohesion were high throughout the program, and therapist-rated participant openness, trust, and motivation strengthened over time. The findings provide further support for the expansion of AYA cancer support services to the online domain.
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Affiliation(s)
- Brittany C McGill
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, Australia .,2 Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia
| | - Ursula M Sansom-Daly
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, Australia .,2 Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia .,3 Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital , Randwick, Australia
| | - Claire E Wakefield
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, Australia .,2 Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia
| | - Sarah J Ellis
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, Australia .,2 Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia
| | - Eden G Robertson
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, Australia .,2 Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia
| | - Richard J Cohn
- 1 Discipline of Paediatrics, School of Women's and Children's Health, UNSW Sydney, Australia .,2 Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital , Randwick, Australia
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LaRosa KN, Stern M, Bleck J, Lynn C, Hudson J, Reed DR, Quinn GP, Donovan KA. Adolescent and Young Adult Patients with Cancer: Perceptions of Care. J Adolesc Young Adult Oncol 2017; 6:512-518. [PMID: 28537818 DOI: 10.1089/jayao.2017.0012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescent and young adults with cancer (AYACs) face unique medical, psychosocial, and supportive care needs. The purpose of this study was to identify AYACs perceptions and expectations of cancer care services on and off treatment. METHODS Semistructured interviews were conducted with 23 AYACs aged 19-38 years (13 on and 10 off treatment), who were receiving care at a comprehensive cancer center. Verbatim transcripts were created from audiotaped interviews and hand coded using inductive content analysis methodology. RESULTS Perceptions of optimal care were reported by AYACs through two main themes as follows: perceived barriers and facilitators during treatment. Within each main theme were three subthemes, including perceived facilitators reported as the provision of social support, the website and patient portal, and the educational information provided by the cancer center. Younger female AYACs (age 19-31) on active treatment reported perceived barriers to optimal care related to the management of physical and mental health symptoms, while older patients (age 32 and up) on active treatment endorsed a fear of cancer returning. The third perceived barrier equally endorsed by patients both on and off treatment and across age ranges included limited assistance with financial issues. CONCLUSIONS AYACs reported perceived barriers and facilitators to optimal care. Implications for these findings are discussed in the context of the importance of adding a patient navigator to the AYACs care team.
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Affiliation(s)
- Kayla N LaRosa
- 1 Department of Educational and Psychology Studies, University of South Florida , Tampa, Florida
| | - Marilyn Stern
- 2 Department of Child and Family Studies, University of South Florida , Tampa, Florida.,3 Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa, Florida.,4 Adolescent and Young Adult Program, Moffitt Cancer Center , Tampa, Florida
| | - Jennifer Bleck
- 2 Department of Child and Family Studies, University of South Florida , Tampa, Florida
| | - Courtney Lynn
- 1 Department of Educational and Psychology Studies, University of South Florida , Tampa, Florida
| | - Janella Hudson
- 3 Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa, Florida
| | - Damon R Reed
- 4 Adolescent and Young Adult Program, Moffitt Cancer Center , Tampa, Florida.,5 Sarcoma Program, Moffitt Cancer Center , Tampa, Florida
| | - Gwendolyn P Quinn
- 3 Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa, Florida.,4 Adolescent and Young Adult Program, Moffitt Cancer Center , Tampa, Florida.,6 Morsani College of Medicine, University of South Florida , Tampa, Florida
| | - Kristine A Donovan
- 3 Health Outcomes and Behavior Program, Moffitt Cancer Center , Tampa, Florida.,4 Adolescent and Young Adult Program, Moffitt Cancer Center , Tampa, Florida.,6 Morsani College of Medicine, University of South Florida , Tampa, Florida
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Isenalumhe LL, Fridgen O, Beaupin LK, Quinn GP, Reed DR. Disparities in Adolescents and Young Adults With Cancer. Cancer Control 2017; 23:424-433. [PMID: 27842332 DOI: 10.1177/107327481602300414] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cancer care for adolescents and young adults (AYAs) focuses on the care of patients aged 15 to 39 years. Historically, this group has favorable outcomes based on a preponderance of diagnoses such as thyroid cancers and Hodgkin lymphoma. Improvements in outcomes among the AYA population have lagged behind compared with younger and older populations. METHODS We discuss and review recent progress in AYA patient care and highlight remaining disparities that exist, including financial disadvantages, need for fertility care, limited clinical trial availability, and other areas of evolving AYA-focused research. RESULTS Survival rates have not improved for this age group as they have for children and older adults. Disparities are present in the AYA population and have contributed to this lack of progress. CONCLUSIONS Recognizing disparities in the care of AYAs with cancer has led many medical specialty disciplines to improve the lives of these patients through advocacy, education, and resource development. Research addressing barriers to clinical trial enrollment in this population, quality-of-life issues, and the improvement of survivorship care is also under way.
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Salem H, Johansen C, Schmiegelow K, Winther JF, Wehner PS, Hasle H, Rosthøj S, Kazak AE, E. Bidstrup P. FAMily-Oriented Support (FAMOS): development and feasibility of a psychosocial intervention for families of childhood cancer survivors. Acta Oncol 2017; 56:367-374. [PMID: 28080169 DOI: 10.1080/0284186x.2016.1269194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND We developed and tested the feasibility of a manualized psychosocial intervention, FAMily-Oriented Support (FAMOS), a home-based psychosocial intervention for families of childhood cancer survivors. The aim of the intervention is to support families in adopting healthy strategies to cope with the psychological consequences of childhood cancer. The intervention is now being evaluated in a nationwide randomized controlled trial (RCT). METHODS AND DESIGN FAMOS is based on principles of family systems therapy and cognitive behavioral therapy, and is delivered in six sessions at home. Families were recruited from all four pediatric oncology departments in Denmark after the end of intensive cancer treatment. We evaluated the feasibility of the intervention and of a RCT design for comparing the intervention with usual care. The evaluation was conducted among families enrolled in the study by tracking procedures and parents' evaluations. RESULTS A total of 68 families (68 mothers, 60 fathers, 68 children with cancer and 73 siblings) were enrolled, with a participation rate of 62% of families. Fathers were highly represented (88% of families); also families with single parents (12%) and parents with basic education (7-12 years of primary, secondary, and grammar school education) were represented (12%). The dropout rate was 12% of families (all in the control group), and two families did not complete the intervention because of relapse. Evaluation by parents in the intervention group showed overall satisfaction with the format, timing, and content of the intervention. CONCLUSION The results indicate that the FAMOS intervention is feasible in terms of recruitment, retention, and acceptability. The effects of the intervention on post-traumatic stress, depression, anxiety, family functioning, and quality of life will be reported after the nationwide RCT has been completed.
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Affiliation(s)
- Hanin Salem
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Finsen Centre, Rigshospitalet, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- University Hospital Rigshospitalet, Institute of Clinical Medicine, Medical Faculty, University of Copenhagen, Copenhagen, Denmark
| | | | - Peder Skov Wehner
- Department of Pediatric Hematology and Oncology, H.C. Andersen Children’s Hospital, Odense University Hospital, Denmark
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Steen Rosthøj
- Department of Pediatrics, Aalborg Hospital, Aalborg, Denmark
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE, USA
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Penn A, Kuperberg A, Zebrack BJ. Psychosocial Issues in Adolescent and Young Adult Patients and Survivors. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Gillies D, Maiocchi L, Bhandari AP, Taylor F, Gray C, O'Brien L. Psychological therapies for children and adolescents exposed to trauma. Cochrane Database Syst Rev 2016; 10:CD012371. [PMID: 27726123 PMCID: PMC6457979 DOI: 10.1002/14651858.cd012371] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children and adolescents who have experienced trauma are at high risk of developing post-traumatic stress disorder (PTSD) and other negative emotional, behavioural and mental health outcomes, all of which are associated with high personal and health costs. A wide range of psychological treatments are used to prevent negative outcomes associated with trauma in children and adolescents. OBJECTIVES To assess the effects of psychological therapies in preventing PTSD and associated negative emotional, behavioural and mental health outcomes in children and adolescents who have undergone a traumatic event. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group's Specialised Register to 29 May 2015. This register contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We also checked reference lists of relevant studies and reviews. We did not restrict the searches by date, language or publication status. SELECTION CRITERIA All randomised controlled trials of psychological therapies compared with a control such as treatment as usual, waiting list or no treatment, pharmacological therapy or other treatments in children or adolescents who had undergone a traumatic event. DATA COLLECTION AND ANALYSIS Two members of the review group independently extracted data. We calculated odds ratios for binary outcomes and standardised mean differences for continuous outcomes using a random-effects model. We analysed data as short-term (up to and including one month after therapy), medium-term (one month to one year after therapy) and long-term (one year or longer). MAIN RESULTS Investigators included 6201 participants in the 51 included trials. Twenty studies included only children, two included only preschool children and ten only adolescents; all others included both children and adolescents. Participants were exposed to sexual abuse in 12 trials, to war or community violence in ten, to physical trauma and natural disaster in six each and to interpersonal violence in three; participants had suffered a life-threatening illness and had been physically abused or maltreated in one trial each. Participants in remaining trials were exposed to a range of traumas.Most trials compared a psychological therapy with a control such as treatment as usual, wait list or no treatment. Seventeen trials used cognitive-behavioural therapy (CBT); four used family therapy; three required debriefing; two trials each used eye movement desensitisation and reprocessing (EMDR), narrative therapy, psychoeducation and supportive therapy; and one trial each provided exposure and CBT plus narrative therapy. Eight trials compared CBT with supportive therapy, two compared CBT with EMDR and one trial each compared CBT with psychodynamic therapy, exposure plus supportive therapy with supportive therapy alone and narrative therapy plus CBT versus CBT alone. Four trials compared individual delivery of psychological therapy to a group model of the same therapy, and one compared CBT for children versus CBT for both mothers and children.The likelihood of being diagnosed with PTSD in children and adolescents who received a psychological therapy was significantly reduced compared to those who received no treatment, treatment as usual or were on a waiting list for up to a month following treatment (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.34 to 0.77; number needed to treat for an additional beneficial outcome (NNTB) 6.25, 95% CI 3.70 to 16.67; five studies; 874 participants). However the overall quality of evidence for the diagnosis of PTSD was rated as very low. PTSD symptoms were also significantly reduced for a month after therapy (standardised mean difference (SMD) -0.42, 95% CI -0.61 to -0.24; 15 studies; 2051 participants) and the quality of evidence was rated as low. These effects of psychological therapies were not apparent over the longer term.CBT was found to be no more or less effective than EMDR and supportive therapy in reducing diagnosis of PTSD in the short term (OR 0.74, 95% CI 0.29 to 1.91; 2 studies; 160 participants), however this was considered very low quality evidence. For reduction of PTSD symptoms in the short term, there was a small effect favouring CBT over EMDR, play therapy and supportive therapies (SMD -0.24, 95% CI -0.42 to -0.05; 7 studies; 466 participants). The quality of evidence for this outcome was rated as moderate.We did not identify any studies that compared pharmacological therapies with psychological therapies. AUTHORS' CONCLUSIONS The meta-analyses in this review provide some evidence for the effectiveness of psychological therapies in prevention of PTSD and reduction of symptoms in children and adolescents exposed to trauma for up to a month. However, our confidence in these findings is limited by the quality of the included studies and by substantial heterogeneity between studies. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies for children exposed to trauma, particularly over the longer term. High-quality studies should be conducted to compare these therapies.
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Affiliation(s)
- Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | | | - Fiona Taylor
- Sydney West Area Mental Health ServicePrevention, Early Intervention and Recovery Service2A Fennell StreetParramattaNSWAustralia2150
| | - Carl Gray
- Western Sydney Local Health Network, New South Wales Health ServiceDepartment of Child and Adolescent PsychiatryRedbank HouseInstitute RoadWestmeadNSWAustralia2145
| | - Louise O'Brien
- University of Newcastle and Greater Western Area Health Service, New South Wales Health ServiceSchool of Nursing and MidwiferyBloomfield Campus, Centre for Rural and Remote Mental HealthLocked Bag 6005OrangeNSWAustralia2800
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Donovan KA, Knight D, Quinn GP. Palliative Care in Adolescents and Young Adults With Cancer. Cancer Control 2016; 22:475-9. [PMID: 26678974 DOI: 10.1177/107327481502200413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer survival rates for adolescents and young adults (AYA) have not improved over time relative to children or adults older than 39 years of age. Palliative care is specialized medical care focused on the control of symptoms and relief of suffering with the goal of improving quality of life for the patient and his or her family. To date, the integration of palliative care in AYA patients with cancer remains suboptimal. METHODS We explore the role of palliative care in the continuum of clinical care for AYA patients with cancer. RESULTS Clinical practice guidelines highlight the need for integrating palliative care for all patients with cancer, including the AYA population. Despite this, a paucity of evidence exists regarding the use of palliative care with AYA patients with cancer. Graduate clinical education represents an opportunity to promote the full inclusion and early integration of palliative care in the care of AYA patients with cancer. Advance care planning is one area where some agreement exists on the unique needs of AYA patients and their families. CONCLUSIONS In general, palliative care is seen as being synonymous with end-of-life care for patients with cancer. However, the emerging trend toward standardizing oncology care to meet the unique medical, psychosocial, and supportive care needs of AYA patients with cancer and their families represents an opportunity for health care professionals to collaborate early with palliative care specialists to control symptoms and relieve suffering in this vulnerable population.
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Robertson EG, Sansom-Daly UM, Wakefield CE, Ellis SJ, McGill BC, Doolan EL, Cohn RJ. Sexual and Romantic Relationships: Experiences of Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2016; 5:286-91. [DOI: 10.1089/jayao.2015.0061] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eden G. Robertson
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Ursula M. Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Randwick, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah J. Ellis
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Brittany C. McGill
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Emma L. Doolan
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Richard J. Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Kensington, Australia
- Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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