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Larsen EH, Wahl AK, Ruud E, Mellblom AV, Ålykkja A, Lie HC. Adolescent Cancer Survivors and Their Parents' Experiences With the Transition Off Treatment to Survivorship: A Qualitative Interview Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:172-187. [PMID: 38656765 DOI: 10.1177/27527530231214528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: Transitioning from active cancer treatment to survivorship represents a vulnerable yet underresearched phase for adolescents and their families. Knowledge of their support needs, the challenges they experience, and how they manage them are useful to inform tailored follow-up care. Thus, we aimed to explore their transition experiences. Method: We interviewed 15 adolescents (12-19 years) who had transitioned off of treatment 1 to 47 months prior at Oslo University Hospital's Department of Paediatric Haematology and Oncology and their biological parents (n = 16). The interviews were analyzed using inductive, reflexive thematic analysis inspired by Braun and Clarke. NVivo-12 was used for data management. Results: Four main themes were identified: (a) consequences of cancer beyond transition, (b) transition back to normalcy, (c) survivorship competence, and (d) changes in roles and relationships. The families described happiness and relief but also said that the lingering effects of cancer treatment had a profound impact on day-to-day living. The adolescents expressed closeness with and dependency on their parents, and they perceived family and friends as essential for social readjustment. Discussion: Although adolescent survivors and their parents described a wide variety of strategies for returning to "normalcy," their perspectives also illustrate ongoing psychosocial and educational support needs that changed over time. Our findings indicate a need for improved preparation for and support through the transition. Nurses are well positioned to provide continuous and structured transition support tailored to the needs of the individual survivors and their families.
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Affiliation(s)
- Elna Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Anneli Viktoria Mellblom
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Nydalen, Oslo, Norway
| | - Anette Ålykkja
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
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Bradford N, Cashion C, Holland L, Henney R, Walker R. Coping with cancer: A qualitative study of adolescent and young adult perspectives. PATIENT EDUCATION AND COUNSELING 2022; 105:974-981. [PMID: 34334263 DOI: 10.1016/j.pec.2021.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Cancer can have long-term biopsychological impacts for young people that persist for years. To promote adjustment, it is essential to understand how young people cope, yet this is relatively understudied. METHODS This study explored the coping strategies using semi-structured interviews with 16 young people with cancer aged 15-24 years. Eligible participants were diagnosed within the previous 24 months and recruited through Australian Youth Cancer Services. Transcribed interviews were analysed using content analysis. RESULTS Coping strategies included: seeking support; controlling the focus; avoiding negatives and staying positive; meaning making and; changes with time. During treatment, seeking support, focussing on the present, distraction and avoidance were commonly applied. Following treatment, planning for the future, avoidance of re-traumatising situations and meaning making were used. CONCLUSION Findings support the concept of coping as a dynamic process where different strategies are used depending on the stressor, available resources and previous experiences. PRACTICE IMPLICATIONS Comprehensive, developmentally appropriate psychosocial assessments, open communication, education and information provision, as well as appropriate referral for support are essential, particularly for young cancer survivors identified at risk.
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Affiliation(s)
- Natalie Bradford
- Queensland University of Technology, School of Nursing, Brisbane, Australia; Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research, Brisbane, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia.
| | | | - Lucy Holland
- Queensland University of Technology, School of Nursing, Brisbane, Australia; Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rosyln Henney
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rick Walker
- Queensland Children's Hospital, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Brisbane, Queensland, Australia; The University of Queensland, School of Medicine, Queensland, Australia
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Reinman L, Coons HL, Sopfe J, Casey R. Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors. CHILDREN 2021; 8:children8111058. [PMID: 34828771 PMCID: PMC8618923 DOI: 10.3390/children8111058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 01/23/2023]
Abstract
Adolescent and young adult (AYA) survivors of cancer have diverse psychosocial and medical needs, including those related to fertility and sexual health. Much of the focus of care around issues such as fertility and sexual health tends to be filtered through a biomedical lens. However, it is essential that health care providers assess and support AYA survivors using a biopsychosocial and contextual framework to ensure the most comprehensive and accurate understanding of AYA survivor needs, especially those related to psychosexual health. A trusting relationship between the multi-disciplinary medical team and the AYA survivor that allows for open discussion about the physical and psychosocial components of sexual health is key to providing best care and outcomes.
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Affiliation(s)
- Laura Reinman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
- Correspondence:
| | - Helen L. Coons
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Jenna Sopfe
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (R.C.)
| | - Robert Casey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA; (J.S.); (R.C.)
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Beyond Resilience: A Concept Analysis of Human Flourishing in Adolescents and Young Adults With Cancer. ANS Adv Nurs Sci 2021; 43:172-189. [PMID: 31922987 DOI: 10.1097/ans.0000000000000292] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article explores the concept of human flourishing in the context of adolescents and young adults with cancer, using Rodgers' Evolutionary Concept Analysis method. We describe flourishing in adolescents and young adults with cancer experience as a continuous and dynamic process of growth and maturity among intrapersonal, interpersonal, and person-environmental dimensions. Flourishing adolescents and young adults with cancer achieve internal integration, evoke positive changes in their environments, and ultimately create a harmonious and balanced existence with the outside world. Human flourishing can be a new health care goal that nurses can apply to this population.
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"There Should Have Been a More Holistic Approach"-A Qualitative Study of Young Adult Cancer Survivors' Experiences of Follow-up After Cancer Treatment. Cancer Nurs 2021; 45:E299-E308. [PMID: 33481409 DOI: 10.1097/ncc.0000000000000924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young adult cancer survivors (YACSs) are in a vulnerable period of life with increased risk of severe physical and psychosocial late effects. However, limited research exists on follow-up of YACSs after cancer treatment. OBJECTIVE The aim of this study was to explore how YACSs experience follow-up from the healthcare system after finishing cancer treatment. METHODS Using a qualitative method with an interpretive descriptive design, 20 YACSs were interviewed 4 times over a period of 6 months. The transcribed interviews were analyzed using Systematic Text Condensation. RESULTS Four main themes were identified: "They should have prepared me better," "The GP (general practitioner) does not understand my challenges," "My check-ups are all about cancer relapse," and "I do not know who's in charge." CONCLUSION The findings indicate deficiency in the healthcare system's follow-up of YACSs in terms of preparation for the survival phase, interdisciplinary cooperation, and acknowledgement of late effects, as well as organization of follow-up care within the healthcare system. IMPLICATIONS FOR PRACTICE A more holistic perspective on follow-up care that addresses YACSs' multidimensional challenges is suggested, including a multidisciplinary approach where cancer nurses should play an active role.
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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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Walsh C, Currin-McCulloch J, Simon P, Zebrack B, Jones B. Shifting Needs and Preferences: Supporting Young Adult Cancer Patients During the Transition from Active Treatment to Survivorship Care. J Adolesc Young Adult Oncol 2018; 8:114-121. [PMID: 30312117 DOI: 10.1089/jayao.2018.0083] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study was designed to identify and explore the social support needs and preferences of young adult cancer patients during the transition process from active treatment to survivorship care. METHODS Semi-structured qualitative interviews were conducted with study participants (n = 13, ages 17-25 at the time of cancer diagnosis) within ∼6 months of completion of active treatment and again 3 months later. Participants completed a sociodemographic questionnaire at the first study visit. Applied thematic analysis was used to identify themes from participant interviews. RESULTS Six key themes and 12 subthemes emerged regarding participant interactions with their support system ("Being there," "Staying strong," and "Treat me the same") and health care team ("Connection and relationship building" and "Seeking knowledge and engaging in advocacy"), as well as treatment effects ("Uncertainty, Loss, & Changes in Identity" and "Ups & Downs of Physical Symptoms"), coping strategies ("Keep busy" and "Keep a positive vibe"), support resources ("Support needs change over time"), and post-treatment experiences ("Trying new things to cope with losses" and "Managing expectations with realities"). CONCLUSION Study findings suggest that supportive care needs can change during the transition process from active treatment to survivorship care. Young adult life transitions, such as finding employment and making new friendships, are more stressful when complicated by ongoing physical and psychological treatment effects. Social stressors and potential barriers to participation in supportive care services should be discussed openly with patients and caregivers, especially prior to transitions in care.
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Affiliation(s)
- Casey Walsh
- 1 Steve Hicks School of Social Work, The University of Texas at Austin , Austin, Texas
| | | | - Pamela Simon
- 2 Stanford Adolescent and Young Adult Cancer Program, Lucile Packard Children's Hospital , Palo Alto, California
| | - Brad Zebrack
- 3 University of Michigan School of Social Work , Ann Arbor, Michigan
| | - Barbara Jones
- 1 Steve Hicks School of Social Work, The University of Texas at Austin , Austin, Texas
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Yanamandra U, Saini N, Chauhan P, Sharma T, Khadwal A, Prakash G, Varma N, Lad D, Varma S, Malhotra P. AYA-Myeloma: Real-World, Single-Center Experience Over Last 5 Years. J Adolesc Young Adult Oncol 2017; 7:120-124. [PMID: 28829925 DOI: 10.1089/jayao.2017.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Multiple myeloma (MM) is considered as a disease of the old with the reported median age of 60-70 years. The disease occurred a decade earlier in the Indian subcontinent. The literature on MM in adolescents and young adult (AYA) is limited. We studied the disease characteristics and outcomes of the AYA-MM in the real-world setting. PATIENTS AND METHODS It is a retrospective single-center study conducted at a tertiary care center from North India. Records of all consecutive patients with AYA-MM (15-39 years of age) who were managed from January 1, 2010, to December 30, 2015, were reviewed. Survival was assessed from the date of start of treatment to the last follow-up date or death due to any cause. RESULTS A total of 415 patients managed for MM were included in the study. The frequency of the AYA-MM was 9.6% (40/415) of whom 5 patients were younger than 30 years. There was male preponderance with a median age of the patients being 38 years. The main presenting features were bone pain (55%), fatigue (45%), extramedullary plasmacytomas (20%), and infections (12%) and referral from the peripheral hospital as renal dysfunction (58%). On the evaluation of patients, hypercalcemia, renal impairment, anemia, and lytic lesions were seen in 24.32%, 30%, 52.5%, and 59.25% of patients, respectively. The majority had the high-risk disease (International Staging System [ISS]-III: 75%). Only 22.5% patients were transplanted. The 3-year median overall survival of the study population was 80.21%. CONCLUSION AYA-MM patients have a higher prevalence of extramedullary disease and high-risk disease.
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Affiliation(s)
- Uday Yanamandra
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Neha Saini
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Pooja Chauhan
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Tanya Sharma
- 2 Department of Internal Medicine, Government Medical College and Hospital (GMCH) , Chandigarh, Punjab, India
| | - Alka Khadwal
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Gaurav Prakash
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Neelam Varma
- 3 Department of Hematology, PGIMER, Chandigarh, India
| | - Deepesh Lad
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Subhash Varma
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- 1 Clinical Hematology Division , Department of Internal Medicine, PGIMER, Chandigarh, India
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