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Zhou B, Kwan B, Desai MJ, Nalawade V, Henk J, Viravalli N, Murphy JD, Nathan PC, Ruddy KJ, Shliakhtsitsava K, Su HI, Whitcomb BW. Association of platinum-based chemotherapy with live birth and infertility in female survivors of adolescent and young adult cancer. Fertil Steril 2024; 121:1020-1030. [PMID: 38316209 PMCID: PMC11128346 DOI: 10.1016/j.fertnstert.2024.01.039] [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: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To estimate the effect of platinum-based chemotherapy on live birth (LB) and infertility after cancer, in order to address a lack of treatment-specific fertility risks for female survivors of adolescent and young adult cancer, which limits counseling on fertility preservation decisions. DESIGN Retrospective cohort study. SETTING US administrative database. PATIENTS We identified incident breast, colorectal, and ovarian cancer cases in females aged 15-39 years who received platinum-based chemotherapy or no chemotherapy and matched them to females without cancer. INTERVENTION Platinum-based chemotherapy. MAIN OUTCOME MEASURES We estimated the effect of chemotherapy on the incidence of LB and infertility after cancer, overall, and after accounting for competing events (recurrence, death, and sterilizing surgeries). RESULTS There were 1,287 survivors in the chemotherapy group, 3,192 in the no chemotherapy group, and 34,147 women in the no cancer group, with a mean age of 33 years. Accounting for competing events, the overall 5-year LB incidence was lower in the chemotherapy group (3.9%) vs. the no chemotherapy group (6.4%). Adjusted relative risks vs. no chemotherapy and no cancer groups were 0.61 (95% confidence interval [CI] 0.42-0.82) and 0.70 (95% CI 0.51-0.93), respectively. The overall 5-year infertility incidence was similar in the chemotherapy group (21.8%) compared with the no chemotherapy group (20.7%). The adjusted relative risks vs. no chemotherapy and no cancer groups were 1.05 (95% CI 0.97-1.15) and 1.42 (95% CI 1.31-1.53), respectively. CONCLUSIONS Cancer survivors treated with platinum-based chemotherapy experienced modestly increased adverse fertility outcomes. The estimated effects of platinum-based chemotherapy were affected by competing events, suggesting the importance of this analytic approach for interpretations that ultimately inform clinical fertility preservation decisions.
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Affiliation(s)
- Beth Zhou
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Brian Kwan
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, California
| | - Milli J Desai
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Vinit Nalawade
- Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Joe Henk
- OptumLabs, Eden Prarie, Minnesota
| | | | - James D Murphy
- Moores Cancer Center, University of California San Diego, San Diego, California; Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Paul C Nathan
- Department of Paediatrics, Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ksenya Shliakhtsitsava
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - H Irene Su
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, San Diego, California
| | - Brian W Whitcomb
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts.
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Bennett CR, Doyon K, Barnard JG, Tofthagen C, Galchutt P, Coats HL, Hendricks-Ferguson VL. "God is going to help me get through this": spirituality perspectives from Hispanic adolescent and young adult cancer survivors. Support Care Cancer 2024; 32:348. [PMID: 38743085 DOI: 10.1007/s00520-024-08550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Describe spirituality's role in a sample of Hispanic adolescent and young adult (AYA) cancer survivors. METHODS This phenomenology-informed convergent parallel mixed-methods study aimed to explore participants' lived experiences with hope during cancer treatments and cancer survivorship. A purposive sample of Hispanic AYAs who completed cancer treatments 2-5 years ago were virtually recruited for participation. Participants completed virtual semi-structured interviews about their experiences with hope during cancer treatments and cancer survivorship and prepared narratives about their experiences. Thematic analyses were iteratively performed across the data set to identify final themes. RESULTS Ten Hispanic AYA cancer survivors (mean age 30.2, SD = 4.5) years participated in this pilot study. Seven participants (70%) were female, and three participants (30%) were male. Six participants (60%) experienced non-hematologic malignancies, and four participants (40%) experienced hematologic malignancies. Eight (80%) participants' language preference was Spanish, while two (20%) participants' language preference was English. The theme spirituality and subthemes living by faith, god as a resource, and spiritual gratitude were identified as concepts participants linked to their conceptualization of hope during cancer treatment and survivorship. CONCLUSIONS Hope and spirituality may be conceptually linked to coping behaviors among Hispanic AYA cancer survivors. Hope through faith may be a learned spiritual value in Hispanic AYAs and might play a role in their spiritual and cognitive development. Further research is needed to explore the potentially protective value of hope and spirituality for the Hispanic AYA population.
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Affiliation(s)
- C Robert Bennett
- Division of Nursing Research, Mayo Clinic Arizona, 5777 E Mayo Boulevard, Phoenix, AZ, USA.
| | - Katherine Doyon
- School of Nursing, Boise State University, Norco Building, 1910 University Drive, Boise, ID, USA
| | - Juliana G Barnard
- Qualitative and Mixed Methods Research Core (QM2), ACCORDS (Adult and Child Center for Outcomes Research and Delivery Science), Department of Pediatrics, University of Colorado School of Medicine | Children's Hospital Colorado, Mailstop F443, 1890 North Revere Court, Aurora, CO, USA
| | - Cindy Tofthagen
- Division of Nursing Research, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, USA
| | - Paul Galchutt
- Department of Transforming Chaplaincy, Rush University, 1653 W Congress Pkwy #12, Chicago, IL, USA
| | - Heather L Coats
- College of Nursing, University of Colorado, Education 2 North, Room 4240 Mail Stop C288-18, 13120 E. 19th Avenue, Aurora, CO, USA
| | - Verna L Hendricks-Ferguson
- Trudy Busch Valentine School of Nursing, Saint Louis University, 3525 Caroline Mall, Office #526, Saint Louis, MO, USA
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3
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Houlihan T, Fortune DG, Keohane C, Richards HL. The psychological needs of adolescents and young adults with a diagnosis of myeloproliferative neoplasms: a systematic scoping review of the literature. Leuk Lymphoma 2024; 65:679-683. [PMID: 38324010 DOI: 10.1080/10428194.2024.2313618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Tara Houlihan
- Mercy University Hospital Foundation, Cork, Republic of Ireland
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Republic of Ireland
| | - Dónal G Fortune
- Department of Psychology, University of Limerick, Limerick, Republic of Ireland
| | - Clodagh Keohane
- Department of Haematology, Mercy University Hospital, Cork, Republic of Ireland
| | - Helen L Richards
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Republic of Ireland
- Department of Psychology, University of Limerick, Limerick, Republic of Ireland
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Bozovic Spasojevic I, Ferrari A, De Munter J, Gamble A, Konsoulova-Kirova A, Rizvi K, Schneider C, Balsat M, Castleton A, Gofti-Laroche L, Kienesberger A, Timmermann B, Vormoor J, Saloustros E, Stark DP. Have we made progress in taking care of adolescents and young adults with cancer? Results of a European multi-professional survey. TUMORI JOURNAL 2023; 109:546-554. [PMID: 37486101 DOI: 10.1177/03008916231183477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND It is well documented that traditional health care models do not meet the specific needs of Adolescents and Young Adults (AYA) cancer patients. METHODS We explore a map of the development of age-specific AYA cancer care across Europe, from the perspective of healthcare professionals with an interest in AYA care, in order to understand the specific challenges and map progress over time. An on-line survey was developed by international professional cancer organisations. RESULTS We had 377 respondents from 60 countries. The majority of respondents were physicians 298 (79%), a minority of survey respondents (39, 10.4%) work exclusively with AYA patients, most respondents declared substantial and routine clinical service collaborations to provide care and treatment to AYA with cancer. Policy for the multidisciplinary management of AYA cancer patients commonly appears in Europe now, and was reported by 234 (78.52%) respondents. Specific professional training for AYA cancer care is not uniformly available. CONCLUSION There is considerable opportunity for many organisations to work together in raising the profile of AYA cancer related issues, in providing education and in encouraging research and collaboration.
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Affiliation(s)
- Ivana Bozovic Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Johan De Munter
- University Hospital Ghent Cancer Center, Ghent, Belgium
- European Oncology Nursing Society
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group, Leicester, UK
| | | | | | | | - Marie Balsat
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Leila Gofti-Laroche
- Department of Public Health-University of Grenoble Alps, AYA Unit-Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | | | - Beate Timmermann
- University Medicine Essen, Clinic for Particle Therapy, West German Proton Therapy Center Essen, Essen, Germany
| | - Josef Vormoor
- Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, Netherlands
| | | | - Daniel P Stark
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
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Mersin S, Gülük F, Gülcan E, Eşkazan AE. Current and emerging tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia in young adults. Expert Opin Pharmacother 2023; 24:1703-1713. [PMID: 37482425 DOI: 10.1080/14656566.2023.2240702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is more common in older adults, but nearly 15-20% of the patients is between 15 and 39 years of age. In this age group, patients may seek clinical care a much later period of the disease and they may have a heavier burden of disease. In addition, young patients with CML may face unique challenges related to their age, such as concerns about health care, fertility, or careers. The current standard of care for CML is the use of tyrosine kinase inhibitors (TKIs), which induce remission in most young patients and can achieve long-term disease control. AREAS COVERED This review summarizes age-specific treatment-related conditions, as well as the effectiveness of TKI therapy in this age group. PubMed, Google Scholar, clinicaltrials.gov and other abstract databases were used while preparing this review. The period of 2001-2023 was chosen as the search window. EXPERT OPINION Although we do not have sufficient data, young adult population has a special importance for TKI treatment. Clinical features, efficacy of treatments, and specific conditions in this age group should attract more attention of clinicians and more intensive studies should be conducted in the future.
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Affiliation(s)
- Sinan Mersin
- Department of Hematology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Fatih Gülük
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emirhan Gülcan
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Matsui M, Taku K, Tsutsumi R, Ueno M, Seto M, Makimoto A, Yuza Y. Role of Peer Support in Posttraumatic Growth Among Adolescent and Young Adult Cancer Patients and Survivors. J Adolesc Young Adult Oncol 2023; 12:503-511. [PMID: 36579948 DOI: 10.1089/jayao.2022.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: Adolescents and young adults (AYA) who undergo cancer treatment sometimes report posttraumatic growth (PTG). Although the importance of peer support has been suggested, its association with PTG, especially its five distinct domains, needs to be investigated further in AYA cancer survivors. The present study examined the role of demographics and peer support in PTG among AYA cancer patients and survivors. Methods: The present, multicenter, cross-sectional, web-based study enrolled AYA cancer patients and survivors (median age: 28 years). Of 549 AYA patients recruited, 212 from 11 cancer centers and 12 cancer patient communities agreed to participate by completing a self-reported measure of PTG (Extended Version of the Posttraumatic Growth Inventory-Japanese) and providing information about their diagnosis, treatment, peer support (affiliation with an AYA patient community or friendship with other AYA patients), and social status. Multiple regression analysis was used to identify significant correlations overall and in the five PTG domains. Results: PTG was positively associated with male sex, having a confidant, and friendship with other AYA patients, and negatively associated with cranial radiation. Friendship with other AYA patients was positively associated with four of the five PTG subscales. For the five subscale scores, "cranial radiation" was negatively associated with "relating to others"; "belonging to a religion" was positively associated with "spiritual change"; and "having a confidant" was positively associated with "relating to others" and "new possibility." Conclusion: "Having a confidant" and "friendship with other AYA patients" were positively associated with PTG. Psychosocial interventions mobilizing peer support may contribute to promoting PTG in AYA patients. UMIN000035439.
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Affiliation(s)
- Motohiro Matsui
- Department of Pediatric Hematology Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
- Department of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Kanako Taku
- Department of Psychology, Oakland University, Oakland, Michigan, USA
| | - Rina Tsutsumi
- Department of Nursing, Kyorin University, Mitaka, Tokyo, Japan
| | - Midori Ueno
- Department of Nursing, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Mayuri Seto
- Department of Nursing, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Atsushi Makimoto
- Department of Pediatric Hematology Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Yuki Yuza
- Department of Pediatric Hematology Oncology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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Magnier O, Gofti-Laroche L, Gaspar N, Schiff I, Chevassut D, Desagneaux A, Pagnier A, Pavillet J, De Schlichting E, Bobillier-Chaumont S. Adolescents and Young Adults with Primary Brain Tumor: Description of the Care Pathway of Patients Diagnosed in Grenoble Between 2013 and 2019. J Adolesc Young Adult Oncol 2023; 12:546-554. [PMID: 36409519 DOI: 10.1089/jayao.2022.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: This study was undertaken to describe the Adolescents and Young Adults' (AYA-aged patients') neuro-oncology care pathways at Grenoble Alpes University Hospital according to the French health recommendations. Methods: A retrospective monocentric observational study was conducted between 2020 and 2021, on patients 13-29 years of age, diagnosed from January 2013 to 2019 in our institute with a primary brain tumor, excluding meningiomas, schwannomas, and neurinomas. The detailed analysis took into account the type of care unit (adult or pediatric), whether or not a dedicated AYA support team was involved, and various pretherapeutic actions. Results: Sixty patients were included in this study. Three of the 9 key stages of the care process were completed regardless of the type of management. Management in a pediatric oncology department seems to improve multidisciplinary discussions and access to the AYA team. Collaboration with an AYA team seems to improve the recourse to pediatric advice and supportive care. Conclusions: Increased vigilance at all key steps as defined in the recommendations of the Directorate General of Healthcare Services would significantly improve the overall quality of care for this specific population. In the absence of a dedicated AYA hospitalization unit, interdisciplinary cooperation between the different professionals of the adult and pediatric services is essential, and the involvement of the AYA mobile team is a factor that favors links and exchanges and ultimately an overall improvement in patient care and life. We propose our vision of an ideal AYA neuro-oncology care pathway.
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Affiliation(s)
- Orlane Magnier
- Department of Medical Oncology, Cancer and Blood Diseases, Grenoble Alpes University Hospital, Grenoble, France
| | - Leila Gofti-Laroche
- Department of AYA Unit and Public Health, Grenoble Alpes University Hospital, Grenoble, France
| | - Nathalie Gaspar
- French Society for the Fight against Cancer and Leukemia in Children and Adolescents and AYA Unit, Gustave Roussy Institute, Villejuif, France
| | - Isabelle Schiff
- Department of Pediatric Oncology and Hematology, Grenoble Alpes University Hospital, Grenoble, France
| | - Diane Chevassut
- Department of Medical Oncology, Cancer and Blood Diseases, Grenoble Alpes University Hospital, Grenoble, France
| | - Andréa Desagneaux
- Department of Radiation Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne Pagnier
- Department of Pediatric Oncology and Hematology, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Pavillet
- Department of Medical Oncology, Cancer and Blood Diseases, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Séverine Bobillier-Chaumont
- Department of AYA Unit and Pediatric Oncology and Hematology, Grenoble Alpes University Hospital, Grenoble, France
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8
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O'Daffer A, Comiskey L, Scott SR, Zhou C, Bradford MC, Yi-Frazier JP, Rosenberg AR. Protocol for the promoting resilience in stress management (PRISM) intervention: a multi-site randomized controlled trial for adolescents and young adults with advanced cancer. BMC Palliat Care 2023; 22:60. [PMID: 37189149 DOI: 10.1186/s12904-023-01179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC). METHODS/DESIGN The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC ("control" arm) or with PRISM-AC ("experimental" arm). PRISM is a manualized, skills-based training program comprised of four 30-60 min, one-on-one sessions targeting AYA-endorsed resilience resources (stress-management, goal-setting, cognitive-reframing, and meaning-making). It also includes a facilitated family meeting and a fully equipped smartphone app. The current adaptation includes an embedded advance care planning module. English- or Spanish-speaking individuals 12-24 years old with advanced cancer (defined as progressive, recurrent, or refractory disease, or any diagnosis associated with < 50% survival) receiving care at 4 academic medical centers are eligible. Patients' caregivers are also eligible to participate in this study if they are able to speak and read English or Spanish, and are cognitively and physically able to participate. Participants in all groups complete surveys querying patient-reported outcomes at the time of enrollment and 3-, 6-, 9-, and 12-months post-enrollment. The primary outcome of interest is patient-reported health-related quality of life (HRQOL) and secondary outcomes of interest include patient anxiety, depression, resilience, hope and symptom burden, parent/caregiver anxiety, depression and health-related quality of life, and family palliative care activation. We will conduct intention-to-treat analysis to compare the group means of primary and secondary outcomes between PRISM-AC arm and control arm with regression models. DISCUSSION This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience and reduce distress among AYAs with advanced cancer. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03668223, September 12, 2018.
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Affiliation(s)
| | - Liam Comiskey
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Samantha R Scott
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Denver, Denver, CO, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | | | | | - Abby R Rosenberg
- Dana-Farber Cancer Institute, 450 Brookline Ave, JF7, Boston, MA, 02215, USA.
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Harris Z, Kaizer H, Wei A, Karantanos T, Williams DM, Chaturvedi S, Jain T, Resar L, Moliterno AR, Braunstein EM. Characterization of myeloproliferative neoplasms in the paediatric and young adult population. Br J Haematol 2023; 201:449-458. [PMID: 36647302 PMCID: PMC10121873 DOI: 10.1111/bjh.18650] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
The aim of this study was to compare the genomic features and clinical outcomes between paediatric and young adult patients (PAYA, <40 years) and older adults (OA, ≥40 years) with myeloproliferative neoplasms (MPN) to gain insight into pathogenesis, disease prognosis and management. Of 630 MPN patients, 171 (27%) were PAYA with an average age at diagnosis of 31 years. Females were more prevalent in PAYA than OA (71% vs 58%; p = 0.002), and PAYA more frequently presented with essential thrombocytosis (ET) at diagnosis (67% vs 39%; p < 0.001). The presence of a JAK2 somatic mutation was higher in OA (80.4% vs 64.3%; p < 0.001), while a CALR mutation or lack of any traditional driver mutation was more common in PAYA (20.5% vs 10.5%; p = 0.001, 8.8% vs 3.7%; p = 0.01 respectively). Venous thrombosis was more common in PAYA compared to OA (19.8% vs 10.7%; p = 0.002). PAYA had a higher prevalence of familial MPN and familial cancer predisposition, and two PAYA patients harboured pathogenic germline JAK2 lesions. PAYA demonstrated longer survival from diagnosis than OA (median not reached vs 13 years), while disease transformation was less frequent (19.3% vs 37.9%).
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Affiliation(s)
- Zoey Harris
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Hannah Kaizer
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Aria Wei
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Theodoros Karantanos
- Division of Hematological Malignancies, Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205
| | - Donna M Williams
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Tania Jain
- Division of Hematological Malignancies, Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205
| | - Linda Resar
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Alison R. Moliterno
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Evan M. Braunstein
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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10
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O'Daffer A, Comiskey L, Scott SR, Zhou C, Bradford MC, Yi-Frazier JP, Rosenberg AR. Protocol for The Promoting Resilience in Stress Management (PRISM) Intervention: a multi-site randomized controlled trial for adolescents and young adults with advanced cancer. RESEARCH SQUARE 2023:rs.3.rs-2748874. [PMID: 37066150 PMCID: PMC10104275 DOI: 10.21203/rs.3.rs-2748874/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC). Methods/design: The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC ("control" arm) or with PRISM-AC ("experimental" arm). PRISM is a manualized, skills-based training program comprised of four 30-60 minute, one-on-one sessions targeting AYA-endorsed resilience resources (stress-management, goal-setting, cognitive-reframing, and meaning-making). It also includes a facilitated family meeting and a fully equipped smartphone app. The current adaptation includes an embedded advance care planning module. English- or Spanish-speaking individuals 12-24 years old with advanced cancer (defined as progressive, recurrent, or refractory disease, or any diagnosis associated with < 50% survival) receiving care at 4 academic medical centers are eligible. Patients' caregivers are also eligible to participate in this study if they are able to speak and read English or Spanish, and are cognitively and physically able to participate. Participants in all groups complete surveys querying patient-reported outcomes at the time of enrollment and 3-, 6-, 9-, and 12-months post-enrollment. The primary outcome of interest is patient-reported health-related quality of life (HRQOL) and secondary outcomes of interest include patient anxiety, depression, resilience, hope and symptom burden, parent/caregiver anxiety, depression and health-related quality of life, and family palliative care activation. We will conduct intention-to-treat analysis to compare the group means of primary and secondary outcomes between PRISM-AC arm and control arm with regression models. Discussion This study will provide methodologically rigorous data and evidence regarding a novel intervention to promote resilience and reduce distress among AYAs with advanced cancer. This research has the potential to offer a practical, skills-based curriculum designed to improve outcomes for this high-risk group. Trial registration: ClinicalTrials.gov Identifier NCT03668223, September 12, 2018.
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11
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Alkhathami K, Soman A, Chandy S, Ramamoorthy B, Alqahtani B. Comparing the effects of retro and forward walking on serum adiponectin levels in obese young adults. J Taibah Univ Med Sci 2023; 18:917-925. [PMID: 36852342 PMCID: PMC9958077 DOI: 10.1016/j.jtumed.2023.01.009] [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: 07/16/2022] [Revised: 11/29/2022] [Accepted: 01/18/2023] [Indexed: 01/29/2023] Open
Abstract
Objectives Retro walking or backward walking expends greater energy and places less stress on joints compared with forward walking at a similar speed. This study conducted in obese young men was primarily aimed at comparing the effects of backward walking with forward walking on adiponectin levels. The secondary aim was to describe the effects of concomitant factors, namely C-reactive protein, body mass index (BMI), waist to height ratio, and waist to hip ratio, on adiponectin levels in obese young men. Methods In this randomized comparative study, 102 participants underwent either retro walking or forward walking treadmill training four times a week for 12 weeks before and after which adiponectin, C-reactive protein, BMI, waist to height ratio, and waist to hip ratio were measured. Comparison of the measured values before and after intervention and between the groups was done, and the influence of C-reactive protein, BMI, waist to height ratio, and waist to hip ratio on adiponectin levels was determined. Results Adiponectin levels were significantly increased (p < 0.001) and C-reactive protein, BMI, waist to height ratio, and waist to hip ratio were significantly decreased (p ≤ 0.001) post-intervention. The participants who underwent retro walking training showed a significantly higher change in C-reactive protein levels, BMI, and waist to hip ratio compared to the forward walking group (p < 0.001). Adiponectin levels were influenced by BMI (p < 0.001). Conclusion Retro walking training leads to a greater increase in adiponectin and reduction in C-reactive protein, BMI, waist to height ratio, and waist to hip ratio compared to forward walking, and adiponectin levels are influenced by BMI. Retro walking treadmill training can be preferentially used to decrease cardiovascular risk factors.
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Affiliation(s)
- Khalid Alkhathami
- Department of Health Rehabilitation, College of Applied Medical Sciences, Shaqra University, Shaqra, KSA
| | - Ajith Soman
- Department of Health Rehabilitation, College of Applied Medical Sciences, Shaqra University, Shaqra, KSA,Corresponding address: Department of Health Rehabilitation, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, KSA.
| | - Sunil Chandy
- Department of Clinical Lab Science, College of Applied Medical Sciences, Shaqra University, Shaqra, KSA
| | - Baranitharan Ramamoorthy
- Department of Health Rehabilitation, College of Applied Medical Sciences, Shaqra University, Shaqra, KSA
| | - Bijad Alqahtani
- Department of Health Rehabilitation, College of Applied Medical Sciences, Shaqra University, Shaqra, KSA
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12
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Lazow MA, Salloum R, Pressey JG. Comorbidity Burden in a Cohort of Adolescent and Young Adult Patients Diagnosed with Central Nervous System Tumors and Sarcomas. J Adolesc Young Adult Oncol 2022; 12:215-223. [PMID: 35675692 DOI: 10.1089/jayao.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) oncology patients experience unique biological, behavioral, and socioeconomic challenges, for which provision of care must be tailored. AYAs with central nervous system (CNS) tumors and sarcomas represent a vulnerable population with worse outcomes and potential for serious sequelae from intense multimodal therapy. Comorbidity burden impacts treatment tolerance, adherence, and efficacy, yet has been understudied among these high-risk AYA patients. Methods: Utilizing a validated AYA oncology comorbidity index, we (1) measured comorbid conditions present at diagnosis in AYA-aged patients with CNS tumors and sarcomas and (2) compared baseline comorbidity burden across ascending AYA age groups (15-19, 20-29, and 30-39 years) and with pediatric patients (10-14 years). Results: The cohort included 131 AYAs and 50 pediatric patients. Mean comorbidity score significantly differed between pediatric (0.8) and AYA (1.7) patients, and across ascending age subgroups (0.8 [10-14] < 1.2 [15-19] < 1.7 [20-29] < 2.5 [30-39]). AYAs were significantly more likely than pediatric patients to have ≥2 or ≥3 comorbidities (47% vs. 18%, 24% vs. 6%), with increasing prevalence across ascending age subgroups. Frequency of overweight/obese status, smoking/substance use, obstetric/gynecologic conditions, and cardiovascular comorbidities increased with age. In multivariate analyses adjusting for sex, tumor type, and race, age remained a significant predictor of comorbidity score. Conclusions: AYAs with CNS tumors or sarcomas have a high burden of baseline comorbidities, which increase with age at diagnosis, conferring susceptibility to treatment-related toxicity and mortality. Improving the prognosis for AYAs requires appropriate identification of pre-existing comorbidities and tailoring therapeutic and supportive care accordingly.
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Affiliation(s)
- Margot A Lazow
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Neuro-Oncology Program, Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ralph Salloum
- Pediatric Neuro-Oncology Program, Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph G Pressey
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Rosenberg AR, Zhou C, Bradford MC, Salsman JM, Sexton K, O’Daffer A, Yi-Frazier JP. Assessment of the Promoting Resilience in Stress Management Intervention for Adolescent and Young Adult Survivors of Cancer at 2 Years: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2136039. [PMID: 34817581 PMCID: PMC8613597 DOI: 10.1001/jamanetworkopen.2021.36039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Adolescents and young adults (AYAs) with cancer have a high risk of poor psychosocial outcomes. The Promoting Resilience in Stress Management (PRISM) intervention is one of few psychosocial interventions targeting younger people with cancer that has demonstrated efficacy in a randomized clinical trial. OBJECTIVE To explore 2-year trajectories of patient-reported well-being among AYA cancer survivors. The hypothesis was that AYAs who initially responded to PRISM would report sustained positive changes. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of data from a single-center, parallel, phase 2 randomized clinical trial was conducted from January 2015 to October 2016. Eligible participants were English-speaking AYAs between ages 13 and 25 years with cancer treated at a single, quaternary children's hospital in the US. Participants were randomly assigned (1:1) to PRISM or usual care. Data were analyzed between March 2021 and June 2021. INTERVENTION PRISM is a brief, skills-based coaching program targeting 4 resilience resources (stress management, goal setting, cognitive reframing, and meaning making). MAIN OUTCOMES AND MEASURES Patient-reported cancer-related quality of life (QoL) (PedsQL scale), hope (Hope scale), resilience (Connor-Davidson Resilience scale), and psychological distress (Kessler-6 scale) were collected at baseline, 6, 12, and 24 months. Data from AYAs who remained alive at 24 months were analyzed. Improvement was defined as a positive change in instrument scores between baseline and 6 months (ie, the end of the PRISM program) and used linear mixed effects regression to assess changes over time. RESULTS A total of 57 AYAs were included in analysis at 24 months (62% of 92 randomized). Twenty-six participants (46%) were female; 36 (63%) were between ages 13 and 17 years; and 20 (35%) identified as part of a racial or ethnic minority group (4 [7%] Asian, 11 [19%] Hispanic or Latino, 16 [28%] mixed race or other). PRISM was associated with improved QoL, hope, resilience, and distress between baseline and 6 months, and these associations were sustained for QoL over 12 months (β = 7.4; 95% CI, 0.8 to 14; P = .03) and hope throughout the study period (12 months: β = 6.2; 95% CI, 2.7 to 9.6; P < .001; 24 months: β = 4.6; 95% CI, 1 to 8.3; P = .01). Of those whose scores improved between baseline and 6 months, PRISM participants more commonly reported sustained improvements in QoL (16 of 21 participants [76%] vs 8 of 17 [47%]), hope (14 of 24 participants [58%] vs 6 of 14 [43%]), resilience (9 of 18 participants [50%] vs 4 of 14 [29%]), and distress (14 of 19 participants [74%] vs 6 of 19 [32%]) at 24 months compared with usual care. CONCLUSIONS AND RELEVANCE These results suggest that PRISM was associated with sustained improvements in psychosocial outcomes as reported by adolescents and young adults. Those who responded to PRISM in the first 6 months reported continued well-being 2 years later. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02340884.
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Affiliation(s)
- Abby R. Rosenberg
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Miranda C. Bradford
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Biostatistics, Epidemiology, and Analytics in Research Program, Seattle Children’s Research Institute, Seattle, Washington
| | - John M. Salsman
- Wake Forest School of Medicine and Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina
| | - Katie Sexton
- Department of Medical Education, University of Washington School of Medicine, Seattle
| | - Alison O’Daffer
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
| | - Joyce P. Yi-Frazier
- Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle
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14
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Chen YR, Wang MQ, Li YT, Li P, Ouyang SS, Xu HW, Zhu SL. Prognostic performance of different lymph node classification systems in young gastric cancer. J Gastrointest Oncol 2021; 12:1285-1300. [PMID: 34532088 DOI: 10.21037/jgo-21-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background Accurate staging plays a pivotal role in cancer care. The lymph node (LN) ratio (LNR) and the log odds of positive LNs (LODDS) have been suggested as alternatives to the N staging since the TNM system has the risk of stage migration. The prognostic significance of LNR and LODDS in young patients with gastric cancer (GC) has not been reported. This study aims to investigate the correlations between LNR and LODDS and survival of young patients with GC, and compare the predictive performance of these LN staging methods. Methods GC patients before the age of 40 from 2004 to 2016 in the Surveillance, Epidemiology and End Results database were enrolled. The prognostic evaluation of the N factor, LNR and LODDS was compared using the time-dependent receiver operating characteristic (ROC) analysis, area under the curve (AUC), C-index and Akaike information criterion (AIC). Results Multivariate survival analysis identified that the LNR and LODDS were significantly independent prognostic indicators for overall survival (OS) in young patients with GC and in the subgroups comprised of patients with ≤15 LNs examined. The time-dependent ROC curves of the LNR and LODDS were continuously superior to that of the N factor in predicting OS during the observation period. And the AUCs revealed that the predictive accuracy of the LNR and LODDS was remarkably superior to the N factor at 1 and 3 years (P<0.05). The model incorporating LNR or LODDS had higher C-index and lower AIC when comparing to the model incorporating the N factor. Conclusions The LNR and LODDS improve accuracy of survival risk prediction in young patients with GC when comparing to the N factor. These two novel LN classification methods should be considered as alternatives to the N staging for the prognostic prediction of young patients with GC.
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Affiliation(s)
- Yi-Ru Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Qian Wang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yi-Ting Li
- Department of General Practice, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Su-Shan Ouyang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui-Wen Xu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sen-Lin Zhu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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15
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Liu J, Zhou H, Zhang Y, Fang W, Yang Y, Hong S, Chen G, Zhao S, Chen X, Zhang Z, Xian W, Shen J, Huang Y, Zhao H, Zhang L. Impact of prior cancer history on the overall survival of younger patients with lung cancer. ESMO Open 2021; 5:S2059-7029(20)30013-2. [PMID: 32054633 PMCID: PMC7046373 DOI: 10.1136/esmoopen-2019-000608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/29/2022] Open
Abstract
Background Patients with a history of prior cancer are frequently excluded from cancer trials. Previous studies indicated that prior cancer does not adversely impact clinical outcomes for patients with lung cancer older than 65 years. However, it remains unknown whether these results are applicable to patients with lung cancer aged younger than 65 years old. The study aimed to investigate the impact of prior cancer history on younger patients with lung cancer. Methods We identified younger patients with lung cancer (<65 years) diagnosed between 2004 and 2009 in the Surveillance, Epidemiology, and End Results database. Propensity score matching was performed to balance differences in baseline characteristics between groups. Kaplan-Meier method and the Cox proportional hazards model were used to evaluate the impact of prior cancer on overall survival (OS). Results Among 103 370 eligible patients with lung cancer, 15.18% had a history of prior cancer. Lung and bronchus (25.83%), breast (14.13%), prostate (8.85%) and cervix uteri (4.74%) were the most common prior cancer types. Of prior cancers, 61.56% are localised and regional stages. More than 67.98% of prior cancers were diagnosed within 5 years of the index lung cancer diagnosis. The median times of diagnosis for prior cancers were 38 months. Patients with prior cancer had the same/non-inferior OS as that of patients without a prior cancer diagnosis (propensity score-adjusted HR=1.01, 95% CI=0.99 to 1.04, p=0.324). Subgroup analyses stratified by timing of prior cancer displayed almost the same tendency (p>0.05). Interestingly, early-stage patients with a history of prior cancer had adverse survival curves (p<0.05). Advanced-stage patients with prior cancer had non-inferior survival (p>0.05). Conclusions A prior cancer diagnosis has a heterogeneous effect on the survival of patients with lung cancer aged <65 years across different stages, but further prospective studies are still warranted.
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Affiliation(s)
- Jiaqing Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Gang Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shen Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xi Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Xian
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiayi Shen
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hongyun Zhao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China .,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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16
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Lo AC, Chen B, Samuel V, Savage KJ, Freeman C, Goddard K. Late effects in survivors treated for lymphoma as adolescents and young adults: a population-based analysis. J Cancer Surviv 2021; 15:837-846. [PMID: 33453004 DOI: 10.1007/s11764-020-00976-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The study objective is to describe and quantify the incidence of treatment-induced late effects in AYA lymphoma patients. METHODS Consecutive patients diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) at 15-24 years of age were identified. All patients in British Columbia who received radiation therapy (RT) from 1974 to 2014 with ≥ 5-year survival post-RT were included. Late effects' analyses included only survivors who received RT to the relevant anatomical site(s) and/or relevant chemotherapy, and were reported as cumulative incidence (CI) ± standard error. RESULTS Three hundred and five patients were identified (74% HL). Median age of diagnosis was 21 years. Median follow-up was 19.1 years for secondary malignancy and 7.2 years for other endpoints. Hypothyroidism was the most prevalent late effect, with a CI of 22.4 ± 2.8% and 35.1 ± 4% at 5 and 10 years, respectively. CI of in-field secondary malignancy was 0.4 ± 0.4% at 10 years and 2.8 ± 1.2% at 20 years. CI of symptomatic pulmonary toxicity was 4.6 ± 1.5% and 6.8 ± 2.0% at 5 and 10 years, respectively, and was higher in patients receiving multiple RT courses (p = 0.009). Esophageal complications occurred at a CI of 1.4 ± 0.8% at 5 years and 2.2 ± 1.1% at 10 years. CI of xerostomia/dental decay was 2.6 ± 1.3% at 5 years and 4.9 ± 2.1% at 10 years. CI of cardiac disease was at 2.3 ± 0.9% at 5 years and 4.4 ± 1.5% at 10 years. CI of infertility was 6.5 ± 1.6% at 5 years and 9.4 ± 2.1% at 10 years. CONCLUSION Survivors of AYA lymphoma have a high incidence and diverse presentation of late effects. IMPLICATIONS FOR CANCER SURVIVORS AYA lymphoma survivors should be educated about their risks of late effects and offered screening and follow-up when appropriate.
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Affiliation(s)
- Andrea C Lo
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Ben Chen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Samuel
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerry J Savage
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Ciara Freeman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre of Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
- Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia (BC) Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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17
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Kakkar N, Gupta A, Sharma NK, Agarwal P, Kaur J. Adolescents and young adults: A study of distribution of cancer at ages 15-39 years in a tertiary care hospital from North India: Epidemiological considerations. South Asian J Cancer 2020; 6:180-182. [PMID: 29404301 PMCID: PMC5763633 DOI: 10.4103/sajc.sajc_263_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose: This study aimed to analyze cancer pattern among adolescents and young adults (AYA) in a tertiary care center in North India. Materials and Methods: A retrospective study from January 2011 to December 2014 was undertaken on AYA cancer patients (aged 15–39 years). Results: Totally 1077 cases of AYA cancers were identified for analyzing the frequency and pattern of cancer distribution. The most common cancer was head and neck (32%) followed by breast (14.2%). The distribution pattern was observed to be varying in different age groups with lymphoma, leukemia, bone tumors, and sarcomas in adolescents while carcinomas being more frequent in young adults. Conclusion: Cancer distribution patterns are distinct among AYA in terms of epidemiology and biology.
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Affiliation(s)
- Neha Kakkar
- Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ajay Gupta
- Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
| | | | - Prachi Agarwal
- Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
| | - Jaspreet Kaur
- Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
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18
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Ren J, Tong YM, Cui RX, Wang Z, Li QL, Liu W, Qu K, Zhang JY, Liu C, Wan Y. Comparison of survival between adolescent and young adult vs older patients with hepatocellular carcinoma. World J Gastrointest Oncol 2020; 12:1394-1406. [PMID: 33362910 PMCID: PMC7739151 DOI: 10.4251/wjgo.v12.i12.1394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/20/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Due to the special clinical features and biologic characteristics of adolescent and young adult (AYA) cancers, AYA cancers are different from cancers in children and elderly individuals. However, there are few reports on AYA hepatocellular carcinoma (HCC).
AIM To investigate the overall survival (OS) of AYA (15-39 years) and elderly (40-74 years) patients with HCC.
METHODS The data of all the HCC cases were extracted from the Surveillance, Epidemiology, and End Results database from 2004 to 2015 and were then divided into two groups based on age: AYA group (15-39 years) and older group (40-74 years). Kaplan-Meier curves and log-rank tests were used to compare the OS of the two groups. Propensity score matching (PSM) was employed to analyze the OS difference between the two groups. The Cox proportional hazards regression model was used to perform multivariate analysis to explore the risk factors for OS of HCC patients.
RESULTS Compared to elderly cancer patients, AYA patients with HCC had a worse Surveillance, Epidemiology, and End Results stage, including the distant stage (22.1% vs 15.4%, P < 0.001), and a more advanced American Joint Committee on Cancer (AJCC) stage, including AJCC III and IV (49.2% vs 38.3%, P < 0.001), and were more likely to receive surgery (64.5% vs 47.5%, P < 0.001). Before PSM, the AYA group had a longer survival in months (median: 20.00, interquartile range [IQR]: 5.00-62.50) than the older group (median: 15.00, IQR: 4.00-40.00) (P < 0.001). After PSM, the AYA group still had a longer survival in months (median: 21.00, IQR: 5.00-64.50) than the older group (median: 18.00, IQR: 6.00-53.00) (P < 0.001). The Cox proportional hazards regression model showed that advanced age (hazard ratio [HR] = 1.405, 95%CI: 1.218-1.621, P < 0.001) was a risk factor for OS of HCC patients. In the subgroup analysis, the Cox proportional hazards regression model showed that in AJCC I/II HCC patients, advanced age (HR = 1.749, 95%CI: 1.352-2.263, P < 0.001) was a risk factor for OS, while it was not a risk factor in AJCC III/IV HCC patients (HR = 1.186, 95%CI: 0.997-1.410, P = 0.054) before PSM. After PSM, advanced age (HR = 1.891, 95%CI: 1.356-2.637, P < 0.001) was still a risk factor for OS in AJCC I/II HCC patients, but was not a risk factor for OS in AJCC III/IV HCC patients (HR = 1.192, 95%CI: 0.934-1.521, P = 0.157) after PSM.
CONCLUSION AYA patients with HCC have different clinical characteristics from older adults. In different AJCC stages, the two groups of patients have different OS: In AJCC I/II HCC patients, advanced age is a risk factor for OS, but it is not a risk factor for OS in the AJCC III/IV HCC patient group.
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Affiliation(s)
- Jie Ren
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Ying-Mu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Rui-Xia Cui
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Zi Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Qing-Lin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Wei Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Kai Qu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Jing-Yao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of SICU, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Department of SICU, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yong Wan
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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19
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Pulewka K, Strauss B, Hochhaus A, Hilgendorf I. Clinical, social, and psycho-oncological needs of adolescents and young adults (AYA) versus older patients following hematopoietic stem cell transplantation. J Cancer Res Clin Oncol 2020; 147:1239-1246. [PMID: 33052515 PMCID: PMC7954716 DOI: 10.1007/s00432-020-03419-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
Purpose To analyze demand for information and advice as well as medical, psychological, and social needs of adolescents and young adults (AYAs) and older patients (non-AYA) after hematopoietic stem cell transplantation (HSCT). Methods A questionnaire was sent to 100 HSCT recipients comprising n = 50 AYAs (aged 19–39 years) and n = 50 non-AYAs (> 39 years). The questionnaire covered the categories: (a) patient characteristics; (b) need for advice, on medical, psychological, and social care topics; (c) medical, psychological, and social needs, and (d) preferred forms and channels of information. Results The return rate was 65%. 62.5% of patients indicated medical needs; 41.1% psychological needs, and 64.9% had needs concerning social issues. Among medical aspects, aftercare was important to both groups. Nutrition was of highest interest for AYA, while non-AYAs identified fatigue and vaccination as their most pressing concerns. Body shape/sexuality and relaxation techniques were the most common psychological issues for AYA, while coping strategies were important for both cohorts. Family, relationship and friends were of less interest in both groups. Rehabilitation and premature retirement were of highest interest for both cohorts. The preferred mode of communicating advice was one-to-one conversation in a quiet environment as opposed to informational sessions. Conclusion Despite well-established aftercare programs following HSCT, many patients describe unmet needs regarding medical, psychological, and social policy issues. AYA and non-AYA differ in informational needs after HSCT, and, therefore, age-appropriate informational materials are necessary. Particularly AYA may profit from information covering body-shape/sexuality and nutrition, while both cohorts require information covering coping strategies and aftercare.
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Affiliation(s)
- Kristin Pulewka
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany.,Klinik für Innere Medizin II, Abteilung Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Germany
| | - Bernhard Strauss
- Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Abteilung Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Germany
| | - Inken Hilgendorf
- Klinik für Innere Medizin II, Abteilung Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Germany.
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20
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Fitch MI, Nicoll I, Lockwood G, Chan RJ, Grundy P. Adolescent and Young Adult Perspectives on Challenges and Improvements to Cancer Survivorship Care: How Are We Doing? J Adolesc Young Adult Oncol 2020; 10:432-442. [PMID: 32931343 DOI: 10.1089/jayao.2020.0097] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose was to review main challenges experienced by adolescent and young adult (AYA) cancer survivors (18-34 years) during transition to survivorship and their suggestions regarding improvements needed in care. Methods: A national survey was conducted to identify experiences with follow-up care 1-3 years after cancer treatment. The survey included open-ended questions for respondents to add topics of importance and details for deeper insight. This study presents analysis of open-ended questions about main challenge faced by AYA respondents and their suggestions for improvements in care. Results: Of 575 AYA survey respondents, 497 (86.4%) commented regarding main challenges. Twenty-one indicated that they had no challenges. Of those reporting challenges, 209 (43.9%) named one challenge, 267 (56.1%) identified more than one. In total, 955 challenges were identified with the most frequently cited being physical (n = 462, 48.4%) and psychological (n = 234, 24.5%). A total of 391 survivors wrote 679 suggestions about improvements in care with the majority (n = 248, 69.4%) offering more than one. The most frequently cited suggestions included information/communication (n = 191, 29.8%), naming a range of topics for which information was desired, and access to post-treatment therapies/services (n = 164, 25.5%) such as counseling, physiotherapy, and occupational therapy. The overarching theme was, "I need follow-up care that fits me." Conclusions: AYA cancer survivors are diverse and face unique challenges following treatment, which can have life-long implications and impede their recovery. Personalized follow-up care is highly recommended by these survivors.
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Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Irene Nicoll
- Department of Health Policy and Biostatistics, University of Toronto, Toronto, Canada
| | - Gina Lockwood
- Department of Health Policy and Biostatistics, University of Toronto, Toronto, Canada
| | - Raymond J Chan
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Australia.,Department of Pediatrics and Oncology, Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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21
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Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus. Blood Adv 2020; 3:3297-3306. [PMID: 31698459 DOI: 10.1182/bloodadvances.2019000838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/30/2019] [Indexed: 12/26/2022] Open
Abstract
Metformin was recently found to increase fetal hemoglobin, which is protective in sickle cell disease (SCD). We tested the hypothesis that, among adults with SCD and diabetes mellitus (DM), metformin use is associated with fewer adverse SCD clinical outcomes and lower health care utilization. This is a retrospective cohort study using the MarketScan Medicaid claims database for 2006 to 2016, comparing metformin users and nonusers. Patients on hydroxyurea, insulin, or iron chelation were excluded. Main outcomes included annual rates of all-cause inpatient encounters, all-cause emergency department (ED) encounters, inpatient and ED encounters with SCD codes, vaso-occlusive episodes (VOEs), strokes, acute chest syndrome (ACS), avascular necrosis (AVN), and gallstones. Of 457 adults (median age [interquartile range], 43 years [33-52 years]; 72% female), 142 (31%) were treated with metformin. Adjusted for age, sex, and Charlson Comorbidity Index, metformin users had significantly lower rate ratios of all-cause inpatient encounters (0.68; 95% confidence interval [CI], 0.52-0.88; P < .01), inpatient encounters with SCD codes (0.45; 95% CI, 0.30-0.66; P < .01), ED encounters with SCD codes (0.34; 95% CI, 0.21-0.54; P < .01), VOE (0.22; 95% CI, 0.12-0.41; P < .01), ACS (0.17; 95% CI, 0.05-0.60; P = .01), and AVN (0.30; 95% CI, 0.11-0.87; P = .03). A subgroup analysis of 54 enrollees preinitiation and postinitiation of metformin did not indicate significant changes in rates of clinical events. Metformin was associated with significantly fewer inpatient and ED SCD encounters in adults with SCD and DM; however, confounding of underlying SCD severity cannot be excluded.
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22
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Fladeboe KM, Scott S, Bradford MC, Ketterl TG, Yi-Frazier JP, Rosenberg AR. Sexual Activity and Substance Use Among Adolescents and Young Adults Receiving Cancer Treatment: A Report from the PRISM Randomized Controlled Trial. J Adolesc Young Adult Oncol 2020; 9:594-600. [PMID: 32316824 DOI: 10.1089/jayao.2020.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: Despite health implications, sexual activity and substance use among adolescents and young adults (AYAs) receiving cancer treatment are understudied. Methods: AYAs 12-25 years of age participated in a randomized controlled trial testing the efficacy of a resilience intervention. They were fluent in English and either diagnosed with new cancer (NC) or advanced cancer (AC). At baseline and 6 months, participants self-reported sexual activity and substance use. We describe the percentage of AYAs who endorsed each behavior and a count of total behaviors endorsed by each respondent. We describe frequencies by sex/gender (male/female), age (<18/≥18), and disease status (AC/NC). Results: Participants (N = 92) were majority white/Caucasian (57%), 12-17 years old (73%), and diagnosed with leukemia/lymphoma (62%); 32% had AC. Responses were not associated with the intervention; hence, we summarized data from the whole cohort. At both time points, median behavior endorsed was 2. At baseline and follow-up, 87% and 81% endorsed at least 1 behavior: 13% and 15% were sexually active, 75% and 73% of whom used birth control inconsistently; and 22% and 22% reported drinking alcohol, 31% and 27% using prescription opioids/sedatives, 19% and 22% using other drugs, and 9% and 7% using tobacco. Young adults engaged in most behaviors more frequently than adolescents (e.g., 48% vs. 12% alcohol at baseline); males engaged in sexual activity more frequently than females (e.g., 20% vs. 5% sexually active at baseline); and AYAs with NC engaged in most behaviors more frequently than those with AC (18% vs. 0% sexually active at baseline). Conclusion: AYAs engage in sexual activity and substance use during cancer treatment.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Samantha Scott
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Tyler G Ketterl
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Cancer and Blood Disorders, Seattle Children's Hospital, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Abby R Rosenberg
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Division of Bioethics/Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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23
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Vandermorris A, Sampson L, Korenblum C. Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review. Pediatr Blood Cancer 2020; 67:e28128. [PMID: 31886630 DOI: 10.1002/pbc.28128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 01/03/2023]
Abstract
Adherence is a critical consideration in ongoing efforts to improve outcomes among adolescents and young adults (AYAs) with cancer. In this narrative review, we embed existing conceptualizations of adherence within a developmental context to provide a novel vantage point from which to examine this important issue. Applying this developmentally oriented framework, we summarize the most current literature on strategies to enhance adherence in the AYA population. A developmentally informed approach to working with AYAs can elucidate unique strengths and vulnerabilities of this population and offer a new perspective on opportunities to respond to biopsychosocial barriers to adherence in a strengths-based, collaborative manner.
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Affiliation(s)
- Ashley Vandermorris
- Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
| | - Lorna Sampson
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Chana Korenblum
- Princess Margaret Cancer Centre, University Health Network, Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
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24
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Lau N, Bradford MC, Steineck A, Scott S, Bona K, Yi-Frazier JP, McCauley E, Rosenberg AR. Examining key sociodemographic characteristics of adolescents and young adults with cancer: A post hoc analysis of the Promoting Resilience in Stress Management randomized clinical trial. Palliat Med 2020; 34:336-348. [PMID: 31680625 PMCID: PMC7289194 DOI: 10.1177/0269216319886215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The "Promoting Resilience in Stress Management" intervention is a skills-based, early palliative care intervention with demonstrated efficacy in adolescents and young adults with cancer. AIM Utilizing data from a randomized clinical trial of Promoting Resilience in Stress Management versus Usual Care, we examined whether response to Promoting Resilience in Stress Management differed across key sociodemographic characteristics. DESIGN Adolescents and young adults with cancer completed patient-reported outcome measures of resilience, hope, benefit-finding, quality of life, and distress at enrollment and 6 months. Participants were stratified by sex, age, race, and neighborhood socioeconomic disadvantage based on home address (Area Deprivation Index scores with 8-10 = most disadvantaged). Differences in the magnitude of effect sizes between stratification subgroups were noted using a conservative cutoff of d > 0.5. SETTING/PARTICIPANTS Participants were 12 to 25 years old, English-speaking, and receiving cancer care at Seattle Children's Hospital. RESULTS In total, 92 adolescents and young adults (48 Promoting Resilience in Stress Management, 44 Usual Care) completed baseline measures. They were 43% female, 73% 12 to 17 years old, 64% White, and 24% most disadvantaged. Effect sizes stratified by sex, age, and race were in an expected positive direction and of similar magnitude for the majority of outcomes with some exceptions in magnitude of treatment effect. Those who lived in less disadvantaged neighborhoods benefited more from Promoting Resilience in Stress Management, and those living in most disadvantaged neighborhoods benefited less. CONCLUSION The "Promoting Resilience in Stress Management" intervention demonstrated a positive effect for the majority of outcomes regardless of sex, age, and race. It may not be as helpful for adolescents and young adults living in disadvantaged neighborhoods. Future studies must confirm its generalizability and integrate opportunities for improvement by targeting individual needs.
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Affiliation(s)
- Nancy Lau
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Miranda C Bradford
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA.,Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Steineck
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA.,Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Samantha Scott
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kira Bona
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA
| | - Elizabeth McCauley
- Division of Child Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Abby R Rosenberg
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.,Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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25
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Intracranial Germ Cell Tumors in Adolescents and Young Adults: A 40-Year Multi-Institutional Review of Outcomes. Int J Radiat Oncol Biol Phys 2020; 106:269-278. [DOI: 10.1016/j.ijrobp.2019.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/26/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022]
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26
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de Rojas T, Neven A, Towbin AJ, Carceller F, Bautista F, Riedl D, Sodergren S, Darlington AS, Fernandez-Teijeiro A, Moreno L. Clinical research tools in pediatric oncology: challenges and opportunities. Cancer Metastasis Rev 2020; 39:149-160. [DOI: 10.1007/s10555-020-09856-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Every year 90,000 young people in Europe and the USA are newly diagnosed with cancer. The majority of earlier studies have taken a quantitative perspective, rarely focusing on the importance of religiosity and spirituality. From these premises, this narrative study explores the spiritual needs of emerging adults with cancer and suggests spiritual care practices that would benefit them in their shift to the remission stage. The data were obtained from the experiences of 16 emerging adults who took part in autobiographical interviews and drew life-tree drawings. Narrative-thematic and visual-narrative methods were used to interpret the data. The results show that spiritual needs manifest in multiple areas: existential questions, value-based searching, and religious seeking. Spiritual care should be targeted to issues such as identity, self-blame, understanding personal values, and relationship with God. Furthermore, family and partners should be supported and dreams of the future after cancer encouraged. The needs for spiritual care are manifold and these needs remain for years after the treatment ends.
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28
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Devine KA, Viola AS, Coups EJ, Wu YP. Digital Health Interventions for Adolescent and Young Adult Cancer Survivors. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652583 DOI: 10.1200/cci.17.00138] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This narrative review describes the evidence regarding digital health interventions targeting adolescent and young adult (AYA) cancer survivors. We reviewed the published literature for studies involving Internet, mHealth, social media, telehealth, and other digital interventions for AYA survivors. We highlight selected studies to illustrate the state of the research in this unique patient population. Interventions have used various digital modalities to improve health behaviors (eg, physical activity, nutrition, tobacco cessation), enhance emotional well-being, track and intervene on cancer-related symptoms, and improve survivorship care delivery. The majority of studies have demonstrated feasibility and acceptability of digital health interventions for AYA survivors, but few efficacy studies have been conducted. Digital health interventions are promising to address unmet psychosocial and health information needs of AYA survivors. Researchers should use rigorous development and evaluation methods to demonstrate the efficacy of these approaches to improve health outcomes for AYA survivors.
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Affiliation(s)
- Katie A Devine
- Katie A. Devine, Adrienne S. Viola, and Elliot J. Coups, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Yelena P. Wu, Huntsman Cancer Institute, Salt Lake City, UT
| | - Adrienne S Viola
- Katie A. Devine, Adrienne S. Viola, and Elliot J. Coups, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Yelena P. Wu, Huntsman Cancer Institute, Salt Lake City, UT
| | - Elliot J Coups
- Katie A. Devine, Adrienne S. Viola, and Elliot J. Coups, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Yelena P. Wu, Huntsman Cancer Institute, Salt Lake City, UT
| | - Yelena P Wu
- Katie A. Devine, Adrienne S. Viola, and Elliot J. Coups, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Yelena P. Wu, Huntsman Cancer Institute, Salt Lake City, UT
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29
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Al-Nassan S, Al-Bitar N, Saad D, Zahran A, Elayyan F, Al-Awadi S, Khaleifeh K, Al-Nassan A. Health- Related Quality of Life Among Jordanian Adolescent Cancer Patients Receiving Active Treatment. Asian Pac J Cancer Prev 2019; 20:3107-3111. [PMID: 31653161 PMCID: PMC6982672 DOI: 10.31557/apjcp.2019.20.10.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Indexed: 11/25/2022] Open
Abstract
Aims: The aim of this study was to evaluate quality of life among adolescents diagnosed with malignancies and currently undergoing treatment in the age group of 13-18 years old. Method: The study used a descriptive cross-sectional design. Participants were recruited from the pediatric oncology department at King Hussein Cancer Center in Jordan. The Arabic version of self-report (adolescent 13-18) pediatric quality of life inventory (PedsQLTM ) 4.0 Generic Core Scale was used. Results: Eighty patients were enrolled in the study. The total score of PedsQL 4.0 generic core was 62.0 (SD=16.5). The highest score was for social functioning (mean=85.4, SD=18.4) and the lowest score was school functioning (mean=39.5, SD=28.4). Females had significantly higher scores for health-related quality of life (HRQOL) in school functioning. Type of tumor did not affect HRQOL. Outpatient participants had significantly higher scores for HRQOL in all domains, except in school functioning where inpatients had a significantly higher score. Conclusion: To the best of our knowledge, this is the first study to reveal the HRQOL scores for Jordanian adolescents with cancer. Addressing the special needs in such a unique age group is essential when planning a comprehensive care plan for a better quality of life.
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Affiliation(s)
- Saad Al-Nassan
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Noor Al-Bitar
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Dhuha Saad
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Amani Zahran
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Felasteen Elayyan
- Department of Physical and Occupational Therapy, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Shereen Al-Awadi
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Kawther Khaleifeh
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Anwar Al-Nassan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
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30
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Ann-Yi S, Tanco K, Carmack CL, Liu DD, Bansal S, Williams J, Lim KH, Bruera E. Introducing psychology services to advanced cancer patients: A randomized double-blind trial. Psychooncology 2019; 28:1978-1986. [PMID: 31295757 DOI: 10.1002/pon.5177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT Psychology services utilization in cancer patients remains low due to barriers such as patient/caregiver acceptance of counseling. OBJECTIVE We aimed to determine if the manner of introducing psychology services impacted patients' acceptance of services and to identify factors associated with acceptance and barriers to psychology utilization. METHODS In this double-blind randomized cross-over trial, cancer patients with no prior psychology services observed two video vignettes: (a) physician introducing counselor and psychology services to the patient (PI) and (b) counselor introducing psychology services alone (CI). A counterbalanced design was used to control for order effects. After viewing both videos, patients completed a survey regarding preference, attitudes, and barriers for psychology services. Patients and investigators were blinded to the purpose of the study and content and order of videos, respectively. We hypothesized that patients would prefer physician introduction of counselor. RESULTS One hundred patients participated: 40 (40%) expressed no difference, 34 (34%) preferred PI, and 26 (26%) preferred CI (P > .2). Younger patients (less than 40 years) either preferred PI (86%) or had no preference (14%, P = .01). Most reported awareness of available psychology services (N = 63), and half (N = 50) were offered psychology services by their physician. Only 40 (40%) and 43 (43%) patients felt psychology services would be helpful for them and their family/caregivers, respectively. Patients who perceived psychology as helpful for self or family had higher anxiety (P = .01 and P = .006, respectively). CONCLUSIONS No significant difference was found in patient preference of introducing psychology services except in patients less than 40 years old who preferred PI.
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Affiliation(s)
- Sujin Ann-Yi
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberson Tanco
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cindy L Carmack
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane D Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Swati Bansal
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janet Williams
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyu-Hyoung Lim
- Department of Internal Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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31
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Lau N, Bradford MC, Steineck A, Junkins CC, Yi-Frazier JP, McCauley E, Rosenberg AR. Exploratory analysis of treatment response trajectories in the PRISM trial: Models of psychosocial care. Psychooncology 2019; 28:1470-1476. [PMID: 31037789 DOI: 10.1002/pon.5098] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Adolescents and young adults (AYAs) with cancer are at high risk of negative psychosocial outcomes. Promoting Resilience in Stress Management (PRISM), a novel, brief, skill-based intervention, has demonstrated efficacy in improving psychosocial well-being for AYAs. We utilized data from a recent randomized trial of PRISM versus usual care (UC) to categorize and explore group differences in change trajectories of patient reported outcomes (PROs) over time. METHODS One hundred English-speaking AYAs (aged 12-25 years old) with cancer were randomized to PRISM versus UC. At enrollment and 6 months later, AYAs completed validated PROs measuring resilience (Connor-Davidson Resilience Scale [CDRISC-10]), hope (Hope Scale), benefit finding (Benefit and Burden Scale for Children), cancer-specific quality of life (Pediatric Quality of Life [PedsQL] Cancer Module), and distress (Kessler-6). Patient response trajectories were categorized as "improved," "consistently well," "consistently at risk," or "deteriorated" using minimal clinically important differences (MCIDs) or established measure cutoffs for all PROs. Positive response trajectories consisted of the first two categories ("improved" and "consistently well"), and negative response trajectories consisted of the latter two categories ("consistently at risk" and "deteriorated"). RESULTS Across all PROs, more patients in the PRISM arm "improved" in psychosocial well-being over time, and fewer PRISM recipients "deteriorated" over time. Across all PROs, a greater proportion of PRISM participants (vs UC) experienced positive response trajectories. Across all PROs, a greater proportion of UC participants experienced negative response trajectories. CONCLUSIONS PRISM shows evidence of both a prevention effect and an intervention effect. Thus, PRISM may serve as a viable prevention and early intervention model for psychosocial care.
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Affiliation(s)
- Nancy Lau
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Miranda C Bradford
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Children's Core for Biomedical Statistics, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Angela Steineck
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Courtney C Junkins
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Joyce P Yi-Frazier
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Division of Child Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Abby R Rosenberg
- Palliative Care and Resilience Research Program, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Division of Hematology/Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Korotkin BD, Hoerger M, Voorhees S, Allen CO, Robinson WR, Duberstein PR. Social support in cancer: How do patients want us to help? J Psychosoc Oncol 2019; 37:699-712. [DOI: 10.1080/07347332.2019.1580331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Brittany D. Korotkin
- Tulane Cancer Center, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Michael Hoerger
- Tulane Cancer Center, Tulane University, New Orleans, LA, USA
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Sara Voorhees
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Chynna O. Allen
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | | | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Lo AC, Laperriere N, Hodgson D, Bouffet E, Nicholson J, McKenzie M, Hukin J, Cheng S, Goddard KJ. Canadian patterns of practice for intracranial germ cell tumors in adolescents and young adults. J Neurooncol 2019; 143:289-296. [PMID: 30937607 DOI: 10.1007/s11060-019-03159-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The study objectives were to describe patterns of practice for intracranial germ cell tumors (IGCT) in adolescents and young adults (AYA) and to determine factors associated with practice patterns. METHODS A survey was written containing questions on the management of two 17-year old males, one with localized pineal germinoma and the other with localized pineal non-germinomatous germ cell tumor (NGGCT). An invitation to participate anonymously in the survey was e-mailed to 119 oncologists who treat brain tumors across Canada. RESULTS Seventy-two (61%) of the 119 oncologists participated in the study. For the germinoma case, the most common treatment approaches were whole ventricular radiotherapy (WVRT) and chemotherapy (CH) (56%), WVRT alone (15%), and craniospinal radiotherapy (CSRT) alone (10%); for physicians recommending WVRT + CH, most frequently selected whole ventricular doses were 24 Gy (57%) and 18 Gy (20%). Chemotherapy was included in the treatment of germinoma by 96% of pediatric physicians vs. 54% of adult physicians (P = 0.001). The most common treatment approaches for NGGCT were CSRT + CH (44%), WVRT + CH (21%), and pineal gland RT + CH (15%). The selection of craniospinal vs. smaller-volume RT was not associated with the physicians' specialty, percentage of practice treating brain tumors, number of IGCTs seen, or size of institution. CONCLUSIONS There is wide variation in the management of IGCT in AYA across Canada. A 17-year old male with a localized pineal germinoma is highly likely to receive chemotherapy if managed by a pediatric oncologist, while the same patient is much less likely to receive chemotherapy if managed by an adult oncologist.
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Affiliation(s)
- Andrea C Lo
- BC Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada. .,Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada. .,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada. .,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada.
| | - Normand Laperriere
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada.,The Hospital of Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - David Hodgson
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada.,The Hospital of Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - Eric Bouffet
- The Hospital of Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | | | - Michael McKenzie
- BC Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Juliette Hukin
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Sylvia Cheng
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Karen J Goddard
- BC Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada.,British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
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Sodergren SC, Husson O, Rohde GE, Tomaszewska IM, Griffiths H, Pessing A, Yarom N, Hooker L, Din A, Darlington AS. Does age matter? A comparison of health-related quality of life issues of adolescents and young adults with cancer. Eur J Cancer Care (Engl) 2019; 27:e12980. [PMID: 30485601 DOI: 10.1111/ecc.12980] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) concerns of adolescents and young adults (AYAs) aged 14-25 years were compared with those of older adults (26-60 years) with cancer. METHODS AYAs and older adults receiving curative intent treatment or supportive palliative care for cancer were recruited from eight research centres across Europe. Participants used a rating scale to score the relevance and importance of a list of 77 issues covering 10 areas of HRQoL concern: symptoms; activity restrictions; social; emotional; body image; self-appraisals; outlook on life; lifestyle; treatment-related and life beyond treatment. RESULTS HRQoL issues were reviewed by 33 AYAs and 25 older adults. Several issues were recognised as relevant and important across all age groups: symptoms, emotional impact, outlook on life, lifestyle and treatment-related. A number of issues were more relevant or important to AYAs including interrupted education, greater motivation to achieve academic goals, increased maturity, boredom, fertility and change in living situation. CONCLUSION While there is overlap in several of the HRQoL concerns across the age span, it is important that HRQoL measures used with AYAs capture the diverse and unique psychosocial aspects of this developmental stage.
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Affiliation(s)
| | | | - 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, Krakow, Poland
| | | | - Aya Pessing
- Department of Oral & Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam Yarom
- Department of Oral Pathology and Oral Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Louise Hooker
- Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Amy Din
- School of Health Sciences, University of Southampton, Southampton, UK
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Mou J, Bolieu EL, Pflugeisen BM, Amoroso PJ, Devine B, Baldwin LM, Frank LL, Johnson RH. Delay in Treatment After Cancer Diagnosis in Adolescents and Young Adults: Does Facility Transfer Matter? J Adolesc Young Adult Oncol 2019; 8:243-253. [PMID: 30785806 DOI: 10.1089/jayao.2018.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Timeliness is one of the fundamental yet understudied quality metrics of cancer care. Little is known about cancer treatment delay among adolescent and young adult (AYA) cancer patients. This study assessed cancer treatment delay, with a specific focus on facility transfer and diagnosis/treatment interval. Methods: Based on MultiCare Health System's (MHS's) institutional cancer registry data of AYA patients diagnosed during 2006-2015, this study analyzed patient demographics, insurance, clinical characteristics, and time of diagnosis and treatment initiation. Chi-squared tests, cumulative hazard estimates, and Cox proportional regression were used for univariable analysis. Multivariate regression models were used to test the association between care transfer and days of interval or prolonged delay, controlling for baseline parameters. Results: Of 840 analytic AYA cases identified, 457 (54.5%) were both diagnosed and treated within MHS. A total of 45.5% were either diagnosed or treated elsewhere. Mean and median intervals for treatment initiation were 27.03 (95% CI = 21.94-33.14) and 8.00 days (95% CI = 5.00-11.00), respectively, with significant differences between patients with and without facility transfer. Transfer was significantly correlated with longer length of diagnosis-to-treatment interval. Treatment delay, ≥1 week, was associated with transfer, female sex, older age, no surgery involvement, and more treatment modalities. Treatment delay, ≥4 weeks, was associated with transfer, female sex, no insurance, and no surgery involvement. Conclusion: In a community care setting, the diagnosis-to-treatment interval is significantly longer for transferred AYA cancer patients than for patients without a transfer. Future studies are warranted to explore the prognostic implications and the reasons for delays within specific cancer types.
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Affiliation(s)
- Jin Mou
- 1 MultiCare Institute for Research & Innovation, Tacoma, Washington
| | | | | | - Paul J Amoroso
- 1 MultiCare Institute for Research & Innovation, Tacoma, Washington
| | - Beth Devine
- 3 Department of Health Services, University of Washington, Seattle, Washington
| | - Laura-Mae Baldwin
- 4 Department of Family Medicine, Community Engagement, Institute of Translational Health Sciences, University of Washington, Seattle, Washington
| | - Laura L Frank
- 1 MultiCare Institute for Research & Innovation, Tacoma, Washington
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Abstract
Purpose of Review Over the past two decades, advances have been made in understanding the pathophysiology of cancer-associated weight loss, termed “cachexia.” To date, there is no proven effective intervention to completely reverse cachexia and there are no approved drug therapies to treat it. This paper will review relevant literature in relation to communicating with adolescents and young adults about cancer-associated weight loss. Recent Findings Adolescents and young adults (AYAs) who have cancer are a unique group of patients due to their stage of development and maturity. Summary This article outlines issues specific to this patient cohort that need to be considered to better understand the impact of cachexia and explore pertinent matters when communicating with AYAs in relation to cachexia.
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Essig S, Steiner C, Kühne T, Kremens B, Langewitz W, Kiss A. Communication Skills Training for Professionals Working with Adolescent Patients with Cancer Based on Participants' Needs: A Pilot. J Adolesc Young Adult Oncol 2019; 8:354-362. [PMID: 30648933 DOI: 10.1089/jayao.2018.0078] [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] [Indexed: 11/12/2022] Open
Abstract
Purpose: We aimed to pilot and evaluate communication skills training (CST) for health care professionals (HCPs) interacting with adolescent patients with cancer and their parents based on participants' needs. Methods: We developed and piloted a 2-day CST with physicians and nurses in adolescent oncology. The CST's agenda was determined by the critical incidents reported by the participants. Training consisted of experiential learning based on role-play between HCPs and simulated patients and parents. Whenever suited, short lectures were given on specific communication techniques. Skills were self-assessed by questionnaires before, immediately after, and 6 months after training. We compared the proportion of participants who felt confident in 19 predefined areas of difficult communication before and 6 months after training. Responses to open-ended questions were analyzed qualitatively by thematic analysis. Results: Twenty-six physicians and 24 nurses participated in 6 CSTs. The proportion of participants who felt confident increased significantly in 6 of 19 communication items (p < 0.05). Positive feedback outweighed negative in quantity and quality. Predominant themes immediately after training were the training's practical orientation and intensity, and 6 months later, increased self-confidence and applied communication techniques. Participants noted that the effect diminishes with time, and expressed their need for booster trainings. Conclusion: The results of CST tailored to the specific needs of HCPs in adolescent oncology were promising. We suggest that similar training opportunities are implemented elsewhere.
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Affiliation(s)
- Stefan Essig
- 1 Institute of Primary and Community Care, Lucerne, Switzerland.,2 Swiss Paraplegic Research, Nottwil, Switzerland
| | - Claudia Steiner
- 3 Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Thomas Kühne
- 4 Division of Oncology/Hematology, University Children's Hospital, Basel, Switzerland
| | - Bernhard Kremens
- 5 Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wolf Langewitz
- 3 Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Alexander Kiss
- 3 Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
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Rosenberg AR, Bradford MC, Barton KS, Etsekson N, McCauley E, Curtis JR, Wolfe J, Baker KS, Yi-Frazier J. Hope and benefit finding: Results from the PRISM randomized controlled trial. Pediatr Blood Cancer 2019; 66:e27485. [PMID: 30270489 PMCID: PMC6249081 DOI: 10.1002/pbc.27485] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk for poor psychosocial outcomes, perhaps because they have not acquired skills to navigate the adversities of illness. In a recent phase II randomized controlled trial (RCT), the "Promoting Resilience in Stress Management" (PRISM) intervention was associated with improved patient-reported resilience, quality of life, and distress. In this planned analysis of secondary aims, we hypothesized PRISM would also improve targeted coping skills of hopeful thinking, benefit finding, and goal setting. METHODS We conducted this parallel RCT at Seattle Children's Hospital from January 2015 to October 2016. English-speaking AYAs (12-25 years old) with cancer were randomized one-to-one to PRISM or usual care (UC). PRISM teaches stress-management, goal-setting, cognitive-reframing, and meaning-making skills in four sessions delivered in-person every other week. Participants completed surveys at enrollment and 6 months later. Mixed effects linear regression models evaluated associations between PRISM and benefit finding (Benefit-Finding Scale for Children), hopeful thinking (Hope Scale), and an exploratory outcome of goal setting (queried with open-ended items about participant's goals, measured qualitatively by three blinded reviewers). RESULTS Of N = 92 AYAs (48 PRISM, 44 UC), 73% were 12-17 years old, 43% female, and 62% diagnosed with leukemia or lymphoma. PRISM was associated with improved benefit finding and hope with moderate-to-large effect sizes-benefit finding: +3.1 points, 95% CI 0.0, 6.2, d = 0.4, and P = 0.05; and hope: +3.6 points, 95% CI 0.7, 6.4, d = 0.6, and P = 0.01. We did not detect changes in goal setting (-0.5 points, 95% CI -1.2, 0.3, d = -0.3, P = 0.23). CONCLUSIONS PRISM was associated with improvements in benefit finding and hopeful thinking, two adaptive coping skills which may mitigate long-term psychosocial risk.
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Affiliation(s)
- Abby R. Rosenberg
- Seattle Children’s Research Institute; Center for Clinical and Translational Research; Seattle, WA,Seattle Children’s Research Institute; Treuman Katz Center for Pediatric Bioethics; Seattle, WA,Seattle Children’s Hospital; Center for Cancer and Blood Disorders Center; Seattle, WA,University of Washington School of Medicine; Department of Pediatrics; Seattle, WA
| | - Miranda C. Bradford
- Seattle Children’s Research Institute; Center for Clinical and Translational Research; Seattle, WA
| | - Krysta S. Barton
- Seattle Children’s Research Institute; Center for Clinical and Translational Research; Seattle, WA,Seattle Children’s Research Institute; Treuman Katz Center for Pediatric Bioethics; Seattle, WA
| | - Nicole Etsekson
- Seattle Children’s Research Institute; Center for Clinical and Translational Research; Seattle, WA
| | - Elizabeth McCauley
- Seattle Children’s Research Institute; Center for Child Health, Behavior, and Development; Seattle, WA,University of Washington School of Medicine; Department of Psychiatry and Behavioral Sciences; Seattle, WA
| | - J. Randall Curtis
- Harborview Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine; Seattle, WA,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA,University of Washington School of Medicine, Department of Medicine; Seattle, WA
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care; Boston, MA,Boston Children’s Hospital, Department of Medicine; Boston, MA,Harvard Medical School; Boston, MA
| | - K. Scott Baker
- Seattle Children’s Hospital; Center for Cancer and Blood Disorders Center; Seattle, WA,University of Washington School of Medicine; Department of Pediatrics; Seattle, WA,Fred Hutchinson Cancer Research Center, Clinical Research Division; Seattle, WA
| | - Joyce Yi-Frazier
- Seattle Children’s Research Institute; Center for Clinical and Translational Research; Seattle, WA
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Salivary cortisol reveals overt and hidden anxiety in survivors of childhood cancer attending clinic. J Affect Disord 2018; 240:105-112. [PMID: 30059936 DOI: 10.1016/j.jad.2018.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/11/2018] [Accepted: 07/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Symptoms of anxiety may arise from fear of cancer recurrence and memories of traumatic experiences during treatment. This study aimed to identify changes in mental health and cortisol, a biological marker of stress, associated with oncology surveillance clinic attendance. METHODS Adolescent and young adult (AYA) survivors of childhood cancer (aged 12-30 years, N = 46) attending a survivorship clinic were recruited. The State-Trait Anxiety Inventory, an anxiety self-rating and open answer question, and salivary cortisol collections were completed two weeks before and one day before clinic, on clinic day and two weeks after. RESULTS Trait anxiety scores were consistent with the normal population. State anxiety scores two weeks after clinic were significantly lower than baseline (p = 0.02). Cortisol diurnal slopes were flatter than baseline after clinic (p = 0.02). Evening cortisol levels were significantly higher than baseline two weeks post clinic (p = 0.02). LIMITATIONS Combined results from biological and psychometric assessments can be difficult to interpret. Larger cohorts will further delineate cortisol pathway activity and distress in AYA cancer survivors. CONCLUSIONS Psychometric evidence indicates that AYA survivors of childhood cancer perceive themselves to be less anxious after a survivorship clinic visit. Biological evidence, however, indicates a dysregulation of the hypothalamic-pituitary-adrenal axis which may be linked to clinic attendance. Weak correlations suggest that cortisol may not be a reliable indicator of self-perceived anxiety. This may be due to confounding lifestyle factors influencing the stress response or potential 'coping strategies' developed during past treatment experience which may, hypothetically, have masked self-perceived anxiety.
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Devlin SM, Murphy JD, Yeung HN. A Retrospective Analysis of Pain Burden in Hospitalized Young Adult Cancer Patients Compared with Their Older Adult Counterpart. J Palliat Med 2018; 22:307-309. [PMID: 30383470 DOI: 10.1089/jpm.2018.0212] [Citation(s) in RCA: 4] [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
CONTEXT Research shows an increased symptom burden in young adult (YA) cancer patients compared with their older adult counterpart. OBJECTIVES The purpose of this study was to identify differences in clinical characteristics and related outcomes between YA and older adult cancer patients admitted for cancer-related pain. MATERIALS AND METHODS We retrospectively identified 190 hospitalized patients in a single academic center with admissions for cancer-related pain. Patients were grouped into either "young adult" (18-39) or "older adult" (>40) cohorts. We compared differences in patient characteristics and pain regimens. RESULTS Median oral morphine equivalent per 24 hours was higher in the YA group (194 mg vs. 70 mg, p = 0.010). Younger patients received patient-controlled analgesia (PCA) more frequently (p = 0.023). The number of palliative care consults and adjuvants prescribed did not differ between groups (p > 0.05), although YAs more frequently had an inpatient pain anesthesia consult (p = 0.047). CONCLUSION Findings show increased opioid requirements and PCA use in YAs being treated for malignancy compared with their older adult counterpart.
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Affiliation(s)
- Shannon M Devlin
- 1 Department of Internal Medicine, University of California San Diego , La Jolla, California
| | - James D Murphy
- 2 Department of Radiation Medicine and Applied Sciences, University of California San Diego , La Jolla, California
| | - Heidi N Yeung
- 3 Division of Palliative Medicine and Hematology/Oncology, Department of Internal Medicine, University of California San Diego , La Jolla, California
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Lippe M, Linton B, Jones B. Utilizing a collaborative learning activity to sensitize interprofessional students to palliative care scopes of practice with adolescent and young adults. J Interprof Care 2018; 33:267-269. [DOI: 10.1080/13561820.2018.1538108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Megan Lippe
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Brittany Linton
- San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Barbara Jones
- The Institute for Collaborative Health Research and Practice Founding Steering Committee Member, Center for Health Interprofessional Practice and Education, Austin, TX
- University Distinguished Teaching Professor, Steve Hicks School of Social Work, Austin, TX, USA
- LIVESTRONG Cancer Institutes and Professor of Oncology, Population Health, and Psychiatry, Dell Medical School, Austin, TX, USA
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Rosenberg AR, Bradford MC, McCauley E, Curtis JR, Wolfe J, Baker KS, Yi-Frazier JP. Promoting resilience in adolescents and young adults with cancer: Results from the PRISM randomized controlled trial. Cancer 2018; 124:3909-3917. [PMID: 30230531 DOI: 10.1002/cncr.31666] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/02/2018] [Accepted: 05/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer are at risk for poor psychosocial outcomes. This study aimed to determine whether a novel intervention targeting resilience resources would improve patient-reported resilience, quality of life, and psychological distress. METHODS In this parallel, phase 2 randomized controlled trial, English-speaking AYAs (12-25 years old) with cancer were randomized to the Promoting Resilience in Stress Management (PRISM) intervention or usual care (UC). PRISM is a brief, skills-based intervention targeting stress management, goal setting, cognitive reframing, and meaning making. Participants completed surveys at enrollment and 6 months. Mixed effects regression models evaluated associations between PRISM and the primary outcome (10-item Connor-Davidson Resilience Scale scores) and secondary outcomes (generic and cancer-related quality of life [Pediatric Quality of Life modules], psychological distress [Kessler-6], and anxiety/depression [Hospital Anxiety and Depression]) at 6 months. RESULTS Ninety-two AYAs were enrolled, were randomized, and completed baseline surveys (48 in the PRISM group and 44 in the UC group); 73% were 12 to 17 years old, and 62% had leukemia or lymphoma. Attrition was primarily due to medical complications and/or death; 36 PRISM participants and 38 UC participants completed 6-month surveys. PRISM was associated with improved resilience (+3.0 points; 95% confidence interval [CI], 0.5-5.4; P = .02) and cancer-specific quality of life (+9.6; 95% CI, 2.6-16.7; P = .01) and reduced psychological distress (-2.1; 95% CI, -4.1 to -0.2; P = .03) but not generic quality of life (+7.2; 95% CI, -0.8 to 15.2; P = .08). Although anxiety was similar between the groups, 2 PRISM participants (6%) and 8 UC participants (21%) met the criteria for depression at 6 months (odds ratio, 0.09; 95% CI, 0.01-1.09; P = .06). CONCLUSIONS PRISM was associated with improved psychosocial outcomes in comparison with UC, suggesting that brief, skills-based interventions for AYAs may provide a benefit.
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Affiliation(s)
- Abby R Rosenberg
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Miranda C Bradford
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington.,Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, Seattle, Washington.,Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - K Scott Baker
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington
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Fukushima T, Ogura K, Akiyama T, Takeshita K, Kawai A. Descriptive epidemiology and outcomes of bone sarcomas in adolescent and young adult patients in Japan. BMC Musculoskelet Disord 2018; 19:297. [PMID: 30121085 PMCID: PMC6098838 DOI: 10.1186/s12891-018-2217-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/01/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There have been fewer improvements in the clinical outcomes of adolescent and young adult (AYA) patients with cancer than for children and older adults, possibly because fewer studies focus on patients in this age group. The aims of this study were (1) to determine survival rates of bone sarcoma among AYAs in Japan (for comparison with other age groups), and (2) to establish whether belonging to the AYA age group at diagnosis was correlated with poor cancer survival in Japan. METHODS A total of 3457 patients diagnosed with bone sarcoma (1930 male and 1527 female) were identified from 63,931 records in the Bone and Soft Tissue Tumor (BSTT) registry, a nationwide Japanese database, from 2006 to 2013. The histologic subtypes of bone sarcoma were osteosarcoma, chondrosarcoma, and Ewing sarcoma. The primary endpoints for prognosis were the occurrence of tumor-related death. We compared the epidemiological features of AYAs with other age groups. The cancer survival rates were calculated using the Kaplan-Meier method. Cox proportional hazards models were used to analyze the prognostic factors for cancer survival. RESULTS The majority of AYA had osteosarcoma 631 (56.2%), while 198 (17.6%) had chondrosarcoma. The frequency of bone sarcoma occurrence was highest among AYA patients, who accounted for a marked proportion of patients with each type of sarcoma. With the exception of sarcoma type, AYA patients did not significantly differ from patients in other age groups for any of the investigated clinicopathological parameters. Cancer survival of AYA patients was significantly higher than in the elderly. Univariate and multivariate analyses revealed that AYA status was not a predictor of poor cancer survival. However, older age (≥65 years) was a predictor of poor cancer survival in patients with overall bone sarcoma, osteosarcoma, chondrosarcoma. CONCLUSION This epidemiological study is the first to investigate AYA patients with bone sarcoma using the nationwide BSTT Registry. We found that cancer survival of AYA patients was significantly higher than that of the elderly. AYA status was not a predictor of poor cancer survival in Japan.
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Affiliation(s)
- Takashi Fukushima
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.,Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
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Sodergren SC, Husson O, Rohde GE, Tomaszewska IM, Vivat B, Yarom N, Griffiths H, Darlington AS. A Life Put on Pause: An Exploration of the Health-Related Quality of Life Issues Relevant to Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2018; 7:453-464. [DOI: 10.1089/jayao.2017.0110] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gudrun E. Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, United Kingdom
| | - Iwona M. Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, United Kingdom
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Helen Griffiths
- Department of Psychological Medicine, Oxford University Hospital, Oxford, United Kingdom
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Current situation of cancer among adolescents and young adults in Japan. Int J Clin Oncol 2018; 23:1201-1211. [DOI: 10.1007/s10147-018-1323-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
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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: 28] [Impact Index Per Article: 4.7] [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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Kleinke AM, Classen CF. Adolescents and young adults with cancer: aspects of adherence - a questionnaire study. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2018; 9:77-85. [PMID: 29750063 PMCID: PMC5935189 DOI: 10.2147/ahmt.s159623] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Purpose For adolescents and young adults (AYAs), a cancer diagnosis represents an extraordinary strike in a vulnerable phase of life. They have special needs that the medical system has to take into consideration, and they exhibit a lower degree of therapy adherence than both older and younger patients. The purpose of this study was first to analyze the adherence of AYAs with cancer compared to a group of older patients and, second, to determine correlated parameters, with focus on the psychosocial interaction between physicians and patients. Patients and methods In 2012, a complete 1 year cohort of patients reported, by use of a questionnaire, to the Rostock clinical cancer registry, and a group of older patients were invited to answer a multi-item set of questionnaires on a volunteer basis, leading to a population-based cross-sectional analysis. This included a bias due to non-answering which is unavoidable in such a setting. The questionnaire consisted of well-established standard questionnaires, a questionnaire on adherence that has just recently been published, and a self-written questionnaire focusing on patient–physician relationship. The responses were analyzed for our current study. Results Gender, religion, education, age, anxiety, family atmosphere, or physician–patient relationship were not significantly correlated to adherence in AYAs. However, markedly more AYAs, as compared to the older patients group, considered breaking off therapy and reported suboptimal communication with the physicians. Only the perceived physical illness could be identified as a factor related to adherence among the AYA group. Conclusion Our findings confirm the need for more focused approaches to serve the special needs of AYAs, with particular attention on specific items that showed up discriminating AYAs from older patients, that is, Internet use and communication with physicians. Here, further research is needed to examine adherence to specific treatment protocols.
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Affiliation(s)
- Anne Marie Kleinke
- Oncology and Hematology Unit, Children's Hospital, University Medicine Rostock, Rostock, Germany
| | - Carl Friedrich Classen
- Oncology and Hematology Unit, Children's Hospital, University Medicine Rostock, Rostock, Germany
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Scurti V, Di Ienno S, Fanizza C, Belfiglio M, D'ettorre A, Romero M, Tognoni G. Hospital Discharge Database as a Tool to Monitor Incidence, Survival and Burden of Cancer in Adolescents and Young Adults. TUMORI JOURNAL 2018; 98:19-26. [DOI: 10.1177/030089161209800102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Cancer in young patients (15–39 years) is unique for the distribution of types, therapeutic options and clinical evolution. Administrative databases represent well-documented tools in epidemiology, and in oncology they are very important in those realities without cancer registries. Our study aimed to analyze the occurrence, outcomes and burden of cancer in young patients through the analysis of hospital discharge records. Methods Hospital discharge databases and civil registries were analyzed through record linkage technique. Annual incidence rate (AIR), standardized incidence rate (SR), overall survival, hospitalization rate, and mean number of hospitalizations were evaluated. Results Among 2,330,459 young adults, 1846 new cancer patients had been hospitalized in the analyzed period. The SR was 69.3/100,000/year: 1051, 56.9%, were females (AIR 91.0 and SR 76.0) and 795, 43.1%, were males (AIR 67.6 and SR 62.5). Hematological disease was more frequent in males than females (25.5% vs 14.7%, P <0.0001), whereas solid tumors were more frequent among females (85.3% vs 74.5, P <0.0001). The distribution by diagnostic group showed that among females breast cancer was the most frequent (n = 272, SR 17.2), whereas among males genitourinary tract cancer (n = 245, SR 19.2), especially testicular cancer (n = 187, SR 15.1), was the most frequent. Metastatic disease at diagnosis was already present in 198 patients with a solid cancer (13.3%), whereas 213 (11.5%) developed metastasis in the following years. At 12 months from the diagnosis, 87 of 1488 patients with solid cancers and 35 of 358 patients with hematologic disease failed: overall survival was 94% and 90%, respectively. Patients with a new diagnosis of cancer had produced 6663 hospitalizations, 4640 (69.6%) of which were due to solid tumors, 3992 (59.9%) produced by patients over 29 years old, and 3606 (54.1%) by females. The percentage of day hospital admissions increased proportionally with patient age: 25.7% of all hospitalizations among older adolescents (15–20 years) and 32.9% among young adults of 34–39 years. Conclusions Administrative data have clear advantages in terms of availability and large numbers. Comparison of our results with the literature showed that a health care delivery database can provide useful information for clinical-epidemiologic evaluations in oncology as well as for the analysis of health services utilization.
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Affiliation(s)
- Veronica Scurti
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Sabrina Di Ienno
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Caterina Fanizza
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Maurizio Belfiglio
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Antonio D'ettorre
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Marilena Romero
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Gianni Tognoni
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
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Bradford NK, Greenslade R, Edwards RM, Orford R, Roach J, Henney R. Educational Needs of Health Professionals Caring for Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2018; 7:298-305. [PMID: 29336666 DOI: 10.1089/jayao.2017.0082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Young people with cancer have distinct clinical and psychosocial needs during and after cancer treatment. However, as adolescent and young adult (AYA) cancer is rare, and only recently recognized as specialty, health professionals may not have the skills, competence, and confidence to meet the needs of the young patient with cancer. The aim of this study was to identify the learning needs of health professionals providing cancer care to adolescents and young adults before and following the introduction of a state-wide AYA cancer education program. METHODS A survey of educational needs of health professionals was undertaken in 2013 at the commencement of the Queensland Youth Cancer Service. The survey was used to develop the education program of the service. The education program was delivered across the state in a variety of formats, covering a range of topics throughout 2013-2016. The second survey was completed in 2017. Results were compared to identify if educational needs or the self-rated confidence of health professionals in regard to AYA cancer care had changed over time. RESULTS One hundred twenty-two participants completed the first survey and 73 completed the second. The most prominent educational needs in 2013 were palliative care and biomedical topics such as understanding AYA growth and development as well as specific AYA cancers and treatment. The second survey identified that palliative care education remained important; however, there was a shift toward health professionals request for more psychosocial and practical education on topics including fertility, sexuality, and managing late effects. CONCLUSION To provide high-quality healthcare to AYAs with cancer, health professionals require ongoing opportunities for education and training.
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Affiliation(s)
- Natalie K Bradford
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia .,2 School of Nursing and Institute of Health and Biomedical Innovation , Queensland University of Technology, Brisbane, Australia
| | - Rebecca Greenslade
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia
| | - Rachel M Edwards
- 3 Oncology Services Group, Lady Cilento Children's Hospital , Brisbane, Australia
| | - Rebekah Orford
- 3 Oncology Services Group, Lady Cilento Children's Hospital , Brisbane, Australia
| | - Jane Roach
- 4 Adem Crosby Centre, Oncology, Sunshine Coast University Hospital , Nambour, Australia
| | - Roslyn Henney
- 1 Queensland Youth Cancer Service, Children Health Queensland , Brisbane, Australia
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Patient characteristics and outcomes in adolescents and young adults with classical Philadelphia chromosome-negative myeloproliferative neoplasms. Ann Hematol 2017; 97:109-121. [DOI: 10.1007/s00277-017-3165-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/30/2017] [Indexed: 02/01/2023]
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