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Osmani V, Hörner L, Klug SJ, Tanaka LF. Prevalence and risk of psychological distress, anxiety and depression in adolescent and young adult (AYA) cancer survivors: A systematic review and meta-analysis. Cancer Med 2023; 12:18354-18367. [PMID: 37559504 PMCID: PMC10523984 DOI: 10.1002/cam4.6435] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer survivors (CS) face unique psychosocial challenges, which may affect their mental health. However, there are inconsistencies in AYA definitions and varying prevalence data on psychological distress, anxiety, and depression. We aimed to synthesize published literature on prevalence, risk, longitudinal changes, and predictors for these outcomes and estimate pooled prevalences. METHODS We searched for observational studies published in English before June 1 2022, in PubMed, PsycINFO, Scopus, and Web of Science. Two researchers extracted independently information on study characteristics, prevalence, and risk. The pooled prevalence (PP) of psychological distress, anxiety, and depression was estimated using random-effects models. Geographical region, treatment status, and assessment instruments were considered in stratified meta-analyses. RESULTS Sixty-eight studies were included in the systematic review and 57 in the meta-analyses. We estimated an overall prevalence of 32% (n = 30; 4226/15,213 AYAs; 95% CI, 23%-42%; I2 = 99%) for psychological distress, 29% for anxiety (n = 24; 2828/8751 AYAs; 95% CI, 23%-36%; I2 = 98%), and 24% (n = 35; 3428/16,638 AYAs; 95% CI, 18%-31%; I2 = 98%) for depression. The range of PP of psychological distress varied across geographical regions, treatment status, and assessment instruments. The PP of anxiety varied significantly across continents, while no variations were seen for depression. Studies found higher risks for psychological distress, anxiety, and depression in AYAs compared to older cancer survivors or cancer-free peers. CONCLUSIONS Our research found that one in three AYA-CS experience psychological distress or anxiety and one in four are affected by depression, highlighting the need for specialized psychological services for AYA-CS in oncology settings and AYA-focused interventions.
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Affiliation(s)
- Vanesa Osmani
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Lucy Hörner
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Stefanie J. Klug
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - Luana Fiengo Tanaka
- Chair of Epidemiology, TUM Department of Sport and Health SciencesTechnical University of MunichMunichGermany
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Abstract
PURPOSE OF REVIEW With an increasing number of long-term lymphoma survivors, there has been emphasis on optimizing quality of life and identifying survivorship challenges. This review summarizes the latest advancements pertaining to health-related quality of life and survivorship in lymphoma. RECENT FINDINGS Quality of life can vary from diagnosis through survivorship though some physical, social, and emotional effects may be persistent. Incorporation of patient reported outcomes enables recognition of factors that significantly impact quality of life. A greater understanding of quality of life and survivorship issues has generated momentum for practice change, improving education, and designing behavior related interventions. Patients with lymphoma face many challenges as they navigate their cancer experience. There is a tremendous opportunity to build upon this work through well-designed prospective longitudinal studies aimed at identifying vulnerable patient groups and impactful points of intervention during survivorship.
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3
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Vena JA, Copel LC. Cancer survivorship and quality of life outcomes of adolescents and young adults with lymphoma: An integrative review. Eur J Oncol Nurs 2021; 52:101948. [PMID: 33799021 DOI: 10.1016/j.ejon.2021.101948] [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] [Received: 08/24/2020] [Revised: 01/21/2021] [Accepted: 03/14/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Lymphoma is a common hematologic malignancy of adolescents and young adults. Cancer survivorship and quality of life are two outcomes studied to measure the types and scope of problems cancer patients experience leading to diagnosis, treatment, and long-term survivorship. This integrative literature review aims to review published literature in the adolescent and young adult lymphoma population, emphasizing cancer survivorship and quality of life outcomes. METHODS The integrative review framework by Whittemore and Knafl was used as the guideline for this study. A literature search of three relevant health science databases, including PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Ovid Emcare, was completed. RESULTS Twelve publications were included in the review, including ten quantitative and two qualitative studies. The studies consisted of sample populations from the United States, England, Germany, and the Netherlands; one study was an international, Children's Oncology Group study. The included studies detailed the cancer survivorship and quality of life outcomes of young adults with lymphoma by quantitative retrospective and longitudinal analysis; two studies used descriptive qualitative and grounded theory methods. The limited qualitative and longitudinal research in adolescents and young adults with lymphoma demonstrates a gap in the lived experience of this cancer population and the adherence to long-term survivorship recommendations. CONCLUSION Future research in adolescents and young adults with lymphoma should employ longitudinal and qualitative designs to examine the quality of life from diagnosis through extended survivorship, and the experiences at diagnosis, treatment, post-treatment, and long-term follow up.
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Affiliation(s)
- Joseph A Vena
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, 19085, USA.
| | - Linda C Copel
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, 19085, USA
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4
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Lea S, Martins A, Bassett M, Cable M, Doig G, Fern LA, Morgan S, Soanes L, Smith S, Whelan M, Taylor RM. Issues experienced and support provided to adolescents and young adults at the end of active treatment for cancer: A rapid review of the literature. Eur J Cancer Care (Engl) 2019; 27:e12972. [PMID: 30485604 DOI: 10.1111/ecc.12972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The end of active treatment is a stressful period for adolescents and young adults (AYA), but little is known about AYA experiences at this time point. The aim was to describe the issues young people experienced and identify interventions to support AYA at the end of treatment. METHODS We conducted a rapid review of published primary research to identify what is currently known about AYA experiences of the end of treatment, the issues which arise and existing interventions to support AYA at this time. RESULTS Searches identified 540 papers of which 16 met the inclusion criteria. Five main themes were identified: physical/medical issues; psychological, social and emotional issues; information and support needs; sources of information and support; and difficulties accessing information and support. Within these broader themes, several subthemes were identified and explored further. CONCLUSION Adolescents and young adults are under prepared for the unpredictable and ongoing nature of the physical, psychological and social issues they face at the end of cancer treatment. Enabling young people's inclusion within their relevant social and educational peer networks should be a priority. Timely, structured and equitable information/support is needed to prepare AYA for treatment ending and subsequent reintegration to "everyday" life.
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Affiliation(s)
- Sarah Lea
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Lorna A Fern
- University College London Hospitals NHS Foundation Trust, London, UK.,National Cancer Research Institute, London, UK
| | - Sue Morgan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Louise Soanes
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Rachel M Taylor
- University College London Hospitals NHS Foundation Trust, London, UK
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5
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Lea S, Martins A, Morgan S, Cargill J, Taylor RM, Fern LA. Online information and support needs of young people with cancer: a participatory action research study. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:121-135. [PMID: 30310338 PMCID: PMC6167089 DOI: 10.2147/ahmt.s173115] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose The Internet is a fully integrated part of young people’s life and it is pivotal that online resources are developed to maximize the potential of the Internet to support those living with and beyond cancer. We sought to understand how young people with a cancer diagnosis use the Internet and to what extent information and support needs are met by existing online resources. Patients and methods This was a participatory action research study involving 21 young people participating in workshops and individual interviews. Participants aged 13–24 years were diagnosed with a range of cancers. Young people were on treatment or had completed treatment; some had experienced relapse. Workshops consisted of participatory methods including focus group discussions, interactive activities, and individual thought, encompassing online resources used; when, how and what they were searching for, whether resources were helpful and how they could be improved. Results Young people reported using communication platforms, entertainment sites, social media, medical websites, charity websites, and search engines to find information and support. Different online use and needs were described throughout their cancer timeline and online use was generally driven by negative emotions. Seven factors influenced access and engagement: 1) where young people were on their cancer timeline; 2) external influencing factors, such as family and environments; 3) emotional drivers; 4) what young people search for online; 5) resources, websites, and digital platforms used by young people; 6) availability, accessibility, and assessment of online information and resources; 7) emotional responses to using online resources. Conclusion The way young people access and engage with online resources is complex with multiple influencing factors including powerful emotional drivers and responses to Internet searching. There is a need to develop resources that support the holistic needs of young people and this should be done in collaboration with young people.
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Affiliation(s)
- Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK,
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK,
| | - Sue Morgan
- Teenage Cancer Trust Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jamie Cargill
- TYA Cancer Service South West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK,
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK,
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6
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Brunet J, Wurz A, Shallwani SM. A scoping review of studies exploring physical activity among adolescents and young adults diagnosed with cancer. Psychooncology 2018; 27:1875-1888. [PMID: 29719077 DOI: 10.1002/pon.4743] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Physical activity can improve health, functional capacity, and quality of life among children and adults diagnosed with cancer. Physical activity may also offer important benefits to adolescents and young adults diagnosed with cancer (AYAs). We conducted a scoping review to: determine the extent, range, and nature of published studies on physical activity among AYAs; identify knowledge gaps; and provide directions for future research. METHODS We searched 4 electronic databases for published studies. Two authors independently scanned the titles, abstracts, and full-texts against inclusion criteria: original research with humans, published in an English-language peer-reviewed journal, ≥50% of participants were diagnosed with cancer between the ages of 15 and 39 years, and included at least 1 measure of physical activity behavior. Data were extracted from studies meeting these criteria and subsequently summarized narratively. RESULTS Our search yielded 4729 articles; 32 met inclusion criteria. These included 18 cross-sectional and 4 longitudinal studies that explored descriptive (ie, sociodemographic or medical), physical, personal/psychological, social, other health behaviors, and/or other factors as antecedents or correlates of physical activity. The remaining 10 were intervention studies that focused on changing physical activity behavior or on testing the effects of physical activity. CONCLUSIONS We can conclude that physical activity is not well researched among AYAs. More high-quality research adopting longitudinal or intervention study designs that incorporate a range of descriptive, physical, personal/psychological, social, and environmental measures are warranted to better inform the development of behavior change interventions as well as to establish the benefits of physical activity for AYAs.
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Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amanda Wurz
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirin M Shallwani
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
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7
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Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, Dyar R, Darlington AS. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017; 26:1659-1672. [PMID: 28251543 PMCID: PMC5486886 DOI: 10.1007/s11136-017-1520-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
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Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica Robinson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK
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Babashov V, Begen MA, Mangel J, Zaric GS. Economic evaluation of brentuximab vedotin for persistent Hodgkin lymphoma. ACTA ACUST UNITED AC 2017; 24:e6-e14. [PMID: 28270727 DOI: 10.3747/co.24.3369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post-autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer. METHODS We developed a decision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with hl after failure of asct. Administrative data from Ontario were used to set the model parameters. RESULTS In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (qalys) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (icer) of $164,248 per qaly gained. The icer was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities. CONCLUSIONS In light of the available information, brentuximab vedotin has an icer exceeding $100,000 per qaly gained, which is a level often classified as having "weak evidence for adoption and appropriate utilization" in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated icer, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored.
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Affiliation(s)
- V Babashov
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | - M A Begen
- Ivey Business School, Western University, London, ON;; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, and
| | - J Mangel
- Department of Medicine, Division of Hematology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - G S Zaric
- Ivey Business School, Western University, London, ON;; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, and
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9
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Macpherson CF, Hooke MC, Friedman DL, Campbell K, Withycombe J, Schwartz CL, Kelly K, Meza J. Exercise and Fatigue in Adolescent and Young Adult Survivors of Hodgkin Lymphoma: A Report from the Children's Oncology Group. J Adolesc Young Adult Oncol 2016; 4:137-40. [PMID: 26421221 DOI: 10.1089/jayao.2015.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fatigue is a significant problem for adolescent and young adult (AYA) Hodgkin lymphoma (HL) survivors. The relationship between exercise and fatigue is complex. This study explored the trajectory of and the relationship between exercise and fatigue over 36 months post-therapy in a cohort of 103 AYA-aged HL survivors treated on Children's Oncology Group (COG) study AHOD0031. Descriptive statistics and generalized estimating equations were used in this secondary data analysis. Exercise and fatigue improved over time but were unrelated; amount of exercise at end of therapy predicted amount of exercise at 12 (p = 0.02) and 36 (p = 0.0008) months post-therapy.
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Affiliation(s)
- Catherine Fiona Macpherson
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles, California
| | - Mary C Hooke
- School of Nursing, University of Minnesota School of Nursing , Minneapolis, Minnesota
| | - Debra L Friedman
- Vanderbilt University and Vanderbilt-Ingram Cancer Center , Nashville, Tennessee
| | - Kristin Campbell
- Vanderbilt University Medical Center and School of Nursing ; Nashville, Tennessee
| | - Janice Withycombe
- Department of Pediatric Oncology, Palmetto Health Children's Hospital , Columbia, South Carolina
| | - Cindy L Schwartz
- Brown University and Hasbro Children's Hospital ; Providence, Rhode Island
| | - Kara Kelly
- New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center , New York
| | - Jane Meza
- Department of Biostatistics, University of Nebraska Medical Center Department of Biostatistics , Omaha, Nebraska
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10
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Linendoll N, Saunders T, Burns R, Nyce JD, Wendell KB, Evens AM, Parsons SK. Health-related quality of life in Hodgkin lymphoma: a systematic review. Health Qual Life Outcomes 2016; 14:114. [PMID: 27473596 PMCID: PMC4966803 DOI: 10.1186/s12955-016-0515-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/25/2016] [Indexed: 01/28/2023] Open
Abstract
Purpose Hodgkin Lymphoma (HL) is highly curable with well-established treatment regimens; however, the impact on patient’s health-related quality of life (HRQL) from diagnosis through survivorship is unclear. This systematic review aimed to describe the available literature on HRQL in HL, assess the quality of these studies, identify gaps in the literature and recommend further areas of research. Methods Following PRISMA guidelines, we performed a systematic review to include studies assessing the HRQL in HL patients. Articles identified through database searches were screened and data extracted. Quality was evaluated using a 6-point scale, adapted from published HRQL systematic reviews. Results Sixty five articles published between 1986 and 2015 met inclusion criteria. These included 53 (82 %) cross-sectional studies; 12 (18 %) longitudinal studies, including three embedded in randomized trials; and three additional longitudinal studies that began assessment at diagnosis. Study sample sizes of HL patients varied considerably with only five (42 %) longitudinal studies including more than 50 patients. Multidimensional HRQL was assessed in 45 studies, single HRQL domains in 22 studies, and symptoms, including fatigue, in 28 studies. Conclusions The majority of studies employed a cross-sectional design, enrolling HL survivors at least 10 years after the completion of therapy. Emphasis on HRQL following therapy may inform initial treatment decisions and long-term survivorship goals. We recommend that future research include prospective, longitudinal randomized designs across both treatment and time.
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Affiliation(s)
- Nadine Linendoll
- Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, #245, Boston, MA, 02111, USA. .,Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA.
| | - Tully Saunders
- Institute for Clinical Research and Health Policy, Tufts Medical Center, 800 Washington Street, #345, Boston, MA, 02111, USA
| | - Rebecca Burns
- Institute for Clinical Research and Health Policy, Tufts Medical Center, 800 Washington Street, #345, Boston, MA, 02111, USA
| | - Jonathan D Nyce
- Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA
| | - Kristen B Wendell
- Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL, 60068, USA
| | - Andrew M Evens
- Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, #245, Boston, MA, 02111, USA.,Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA
| | - Susan K Parsons
- Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, #245, Boston, MA, 02111, USA.,Institute for Clinical Research and Health Policy, Tufts Medical Center, 800 Washington Street, #345, Boston, MA, 02111, USA.,Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA
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11
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Clarke PN, Fawcett J. Life as a Mentor. Nurs Sci Q 2014; 27:213-215. [DOI: 10.1177/0894318414534492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of mentorship is personalized in this discussion of Dr. Fawcett’s life as she experienced and thrived as a mentor. The authors describe different types of mentorship and how they were experienced by this leader.
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Affiliation(s)
- Pamela N. Clarke
- Professor and Director of Community Health, University of Wyoming
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