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O'Donnell N, Phillips B, Morgan JE, Howell D. 'It's not meant to be for life, but it carries on': a qualitative investigation into the psychosocial needs of young retinoblastoma survivors. BMJ Open 2024; 14:e082779. [PMID: 38688668 PMCID: PMC11086577 DOI: 10.1136/bmjopen-2023-082779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE AND DESIGN Retinoblastoma (Rb) is a rare childhood eye cancer, with 45% of individuals impacted by heritable disease and the remainder impacted non-heritably. The condition can leave survivors with life-long psychological and social challenges. This qualitative study examined the psychosocial needs of teenagers and young adults living beyond Rb. SETTING A qualitative, exploratory study was conducted using focus groups with teenagers and interviews with young adults. Participants were recruited via the Childhood Eye Cancer Trust and the two national Rb treatment centres in the UK. Reflexive thematic analysis was used to analyse data using exploratory and inductive methods. PARTICIPANTS 32 young survivors of Rb (10 heritable, 21 non-heritable, 1 unknown; 23 unilateral, 9 bilateral) aged between 13 and 29 years (12 male, 20 female). RESULTS Data were rich and spanned the life course: three key themes were generated, containing eight subthemes. Theme 1 describes participants' experiences of childhood and trauma, including survivor guilt, memories from treatment and impact on personality. Theme 2 focuses on the challenges of adolescence, including the psychological impact of Rb, the impact on identity, and the sense of normality and adaptation to late effects. The third theme considered adulthood and the development of acceptance, a state of being widely considered unachievable during childhood, as well as the 'work' needed to feel supported, including seeking out information, peer support and therapeutic strategies. CONCLUSIONS This study provides in-depth insight into the experiences of life beyond Rb. Findings highlight the need for specific psychosocial interventions informed by codesign.
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Affiliation(s)
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Debra Howell
- Department of Health Sciences, University of York, York, UK
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2
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Huang Y, Guo Y. Quality of life among people with eye cancer: a systematic review from 2012 to 2022. Health Qual Life Outcomes 2024; 22:3. [PMID: 38185647 PMCID: PMC10773080 DOI: 10.1186/s12955-023-02219-6] [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: 08/07/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Eye cancer is a serious eye disease that threatens patients' lives. In the past decade, there have been more and more studies on eye cancer. From the recently published eye cancer literature review, it can be seen that the two most popular research hotspots are retinoblastoma (RB) and uveal melanoma (UM) [1, 2]. Although several studies have assessed QOL in different types of eye cancer patients, a study that synthesizes the factors influencing QOL in eye cancer patients is yet to be undertaken. This study aimed to review and evaluate the literature related to the QOL of RB and UM survivors, and provide a synthesis of the current evidence on the impact of the two types of eye cancer on the overall QOL of patients. METHODS Eight databases (APA Psych Articles, CINAHL Complete, Health Source: Nursing/Academic Edition, MEDLINE Complete, Scopus, Cochrane Library, PubMed, and Registers (Clinicaltrials.gov.)) were searched between January 2012 and December 2022 for English, peer-reviewed quantitative original studies within this review. All publications were screened using the Preferred Reporting Items for Systematic Review and Meta-Analyses reporting guidelines. The methodological quality of the reviews was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. The findings were summarised and tabulated accordingly. RESULTS Seventeen articles were analysed. Among them, 14 articles on patients with UM, and three articles on patients with RB using 18 different types of measurement tools were included. Eight researchers claimed that the overall QOL of patients with eye cancer was better than or similar to that of the general healthy population. However, nine studies indicated that these patients had poorer QOL than others. Many factors affect QOL, including treatment, sex, and age. CONCLUSION This systematic review identified the QOL levels and several factors that influence the QOL of ocular cancer patients worldwide, due to the variability in quality of the studies, it also showed the need for further research to assess factors affecting long-term QOL outcomes in RB and UM survivors. Simultaneously, it clarified the necessity and importance of developing standardized and complete assessment tools to compare QOL in different countries. Early interventions can be developed to improve the survivors' QOL by identifying potential deficits in specific areas.
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Affiliation(s)
- Yonghui Huang
- Henan Provincial People's Hospital, Henan Provincial Eye Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China.
| | - Yunfei Guo
- Henan Provincial People's Hospital, Henan Provincial Eye Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China
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3
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Lee ARYB, Low CE, Yau CE, Li J, Ho R, Ho CSH. Lifetime Burden of Psychological Symptoms, Disorders, and Suicide Due to Cancer in Childhood, Adolescent, and Young Adult Years: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:790-799. [PMID: 37345504 PMCID: PMC10288378 DOI: 10.1001/jamapediatrics.2023.2168] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023]
Abstract
Importance A cancer diagnosis and treatment may result in highly traumatic periods with lasting psychological consequences for children, adolescent, and young adult patients with cancer (CYACs). Early identification and management may prevent long-term psychological morbidity and suicide. Objective To analyze risk, severity, and risk factors for depression, anxiety, psychotic disorders, and suicide in CYACs and noncancer comparators. Data Sources Literature search of PubMed, MEDLINE, Embase, PsycINFO, CINAHL, and PubMed Central from January 1, 2000, to November 18, 2022. Study Selection Full-length articles in peer-reviewed journals that measured and reported risk and/or severity of depression, anxiety, psychotic disorders, and suicide mortality in CYACs and a noncancer comparator group. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed with prospective PROSPERO registration. Main Outcomes and Measures Risk ratios (RRs) were used for dichotomous outcomes, and standardized mean differences (SMDs) were used for continuous outcomes. SMDs were defined as follows: 0.2, small; 0.5, medium; and 0.8, large. Sources of heterogeneity and risk factors were investigated using sensitivity, subgroup, and meta-regression analyses. Results From 7319 records, 52 studies were included. Meta-analyses revealed that CYACs were at increased lifetime risk of severe symptoms or a disorder of depression (RR, 1.57; 95% CI, 1.29-1.92), anxiety (RR, 1.29; 95% CI, 1.14-1.47), and psychotic disorders (RR, 1.56; 95% CI, 1.36-1.80) relative to both matched controls and their siblings. Overall suicide mortality was not significantly elevated (RR, 1.63; 95% CI, 0.78-3.40). The mean severity of depression was found to be elevated in CYACs receiving treatment (SMD, 0.44; 95% CI, 0.13-0.74) and long-term survivors (SMD, 0.18; 95% CI, 0.02-0.33). The mean severity of anxiety was found to be elevated only during treatment (SMD, 0.16; 95% CI, 0.03-0.20). Conclusions and Relevance Findings of this systematic review and meta-analysis suggest that CYACs may experience lasting psychological burden long into survivorship. Timely identification, preventive efforts, and psycho-oncological intervention for psychological comorbidity are recommended.
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Affiliation(s)
- Ainsley Ryan Yan Bin Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Ee Low
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiaqi Li
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
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4
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Wise J, Hayashi R, Wu T, Malone S, Badawi AA, King A, Gordon M, Kimera L, Lueder G, Reynolds M. Eye-related quality of life and activities of daily living in pediatric retinoblastoma patients: A single-center, non-controlled, cross-sectional analysis. Pediatr Blood Cancer 2023:e30479. [PMID: 37269496 DOI: 10.1002/pbc.30479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Childhood retinoblastoma (RB) survivors are known to experience long-term morbidity; however, eye-related quality of life (QoL), which may significantly impact activities of daily living (ADL), has not been extensively studied in this population. The purpose of this cross-sectional study was to assess QoL and ADL morbidity among school-age RB survivors. METHODS The Pediatric Eye Questionnaire (PedEyeQ) and Roll Evaluation Activities of Life (REAL) were administered to childhood RB survivors between ages 5 and 17 followed at St. Louis Children's Hospital. Visual outcomes and demographic predictors of ADL and QoL were examined. RESULTS Total 23 patients (mean age 9.6 years) consented for participation in this study. All children experienced at least one domain on the PedEyeQ ≤ 80%. Subjects and parents marked functional vision to be the most impacted domain with a median score of 82.5 and 83.4, respectively. Only 10.5% of participants scored above 75% on the ADL percentile rank. On multivariable analysis, decreased visual acuity (VA) was associated with worse "Child Functional" (odds ratio [OR] -59.2, p = .004) and "Parent Worry Function" (OR -66.5, p = .03) metrics. Decreased contrast sensitivity was associated with worse "Parent Impact" (OR 21.0, p = .02) and "Parent Worry Function" (OR 3.70, p = .04) metrics. Longer saccade horizontal latency was associated with a worse "Parent Worry Function" metric (OR 43.0, p = .009). On multivariable analysis, no variable was significantly associated with ADL. CONCLUSION RB survivors have impaired QoL and ADL. Screening for such difficulties should strongly be considered for all RB patients. Additional studies may help predict morbidity based on visual metrics and demographic data.
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Affiliation(s)
- Jacob Wise
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Robert Hayashi
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Tiffany Wu
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Sara Malone
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Amer Al Badawi
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Allison King
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Mae Gordon
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Lawrencia Kimera
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Gregg Lueder
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
| | - Margaret Reynolds
- Washington University Saint Louis/Saint Louis Children's Hospital, Saint Louis, Missouri, USA
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5
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Morse M, Parris K, Qaddoumi I, Phipps S, Brennan RC, Wilson MW, Rodriguez-Galindo C, Goode K, Willard VW. Psychosocial outcomes and quality of life among school-age survivors of retinoblastoma. Pediatr Blood Cancer 2023; 70:e29983. [PMID: 36385462 PMCID: PMC9857480 DOI: 10.1002/pbc.29983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Retinoblastoma is the most common intraocular childhood cancer and is typically diagnosed in young children. With increasing number of survivors and improved medical outcomes, long-term psychosocial impacts need to be explored. Thus, the current study sought to assess functioning in school-aged survivors of retinoblastoma. PROCEDURE Sixty-nine survivors of retinoblastoma underwent a one-time evaluation of psychosocial functioning. Survivors (Mage = 10.89 years, SD = 1.07 years; 49.3% male; 56.5% unilateral disease) and parents completed measures of quality of life (QoL; PedsQL) and emotional, behavioral, and social functioning (PROMIS [patient-reported outcome measurement information system] Pediatric Profile, BASC-2 parent report). Demographic and medical variables were also obtained. RESULTS On the whole, both survivors and caregivers indicated QoL and behavioral and emotional health within the typical range of functioning. Survivors reported better physical QoL compared to both parent report and a national healthy comparison sample, whereas caregivers reported that survivors experienced lower social, school, and physical QoL than a healthy comparison. Regarding behavioral and emotional health, survivors indicated more anxiety than a nationally representative sample. Parents of female survivors endorsed lower adaptive scores than parents of male survivors. CONCLUSIONS Results indicated that survivors of retinoblastoma reported QoL and behavioral and emotional health within normal limits, although parents appear to perceive greater impairment across several assessed domains. Understanding both survivor and parent reports remains important for this population. Future research should explore psychosocial functioning of these survivors as they transition to adolescence and early adulthood, given the increased independence and behavioral and emotional concerns during these developmental periods.
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Affiliation(s)
- Melanie Morse
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kendra Parris
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Sean Phipps
- St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | | | | | - Kristin Goode
- St. Jude Children’s Research Hospital, Memphis, Tennessee
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Zhuang L, Chen Q, Chen H, Zheng X, Liu X, Feng Z, Wu S, Liu L, Shen X. Breast cancer-related lymphedema and recurrence of breast cancer: Protocol for a prospective cohort study in China. PLoS One 2023; 18:e0285772. [PMID: 37192209 DOI: 10.1371/journal.pone.0285772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION The primary aim is to determine the factors associated with breast cancer-related lymphedema and to identify new associated factors for the recurrence of breast cancer and depression. The secondary objective is to investigate the incidence of breast cancer-related events (breast cancer-related lymphedema, recurrence of breast cancer, and depression). Finally, we want to explore and validate the complex relationship among multiple factors influencing breast cancer complications and breast cancer recurrence. PATIENTS AND METHODS A cohort study of females with unilateral breast cancer will be conducted in West China Hospital between February 2023 and February 2026. Breast cancer survivors in the age range of 17-55 will be recruited before breast cancer surgery. We will recruit 1557 preoperative patients with a first invasive breast cancer diagnosis. Consenting breast cancer survivors will complete demographic information, clinicopathological factors, surgery information, baseline information, and a baseline depression questionnaire. Data will be collected at four stages: the perioperative stage, chemotherapy therapy stage, radiation therapy stage, and follow-up stage. Data including the incidence and correlation of breast cancer-related lymphedema, breast cancer recurrence, depression, and medical cost will be collected and computed through the four stages above. For every statistical analysis, the participants will be classified into two groups based on whether they develop secondary lymphedema. Incidence rates of breast cancer recurrence and depression will be calculated separately for groups. Multivariate logistic regression will be used to determine whether secondary lymphedema and other parameters can predict breast cancer recurrence. DISCUSSION Our prospective cohort study will contribute to establishing an early detection program for breast cancer-related lymphedema and recurrence of breast cancer, which are both associated with poor quality of life and reduced life expectancy. Our study can also provide new insights into the physical, economic, treatment-related and mental burdens of breast cancer survivors.
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Affiliation(s)
- Linli Zhuang
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian Chen
- Center of Biostatistics, Design, Measurement and Evaluation, Department of Clinical Research Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huaying Chen
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuemei Zheng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Liu
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenzhen Feng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Unit of Cancer Day Care, West China Hospital, Sichuan University, Chengdu, China
| | - Shaoyong Wu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Liu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Shen
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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7
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Belson PJ, Eastwood JA, Brecht ML, Kim JW, Hays RD, Pike NA. Health-Related Quality of Life in Adolescent and Young Adult Retinoblastoma Survivors. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:342-357. [PMID: 35674414 PMCID: PMC9807776 DOI: 10.1177/27527530221073766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Retinoblastoma (RB) is a malignant intraocular tumor diagnosed in early childhood that requires extensive medical and surgical treatment at a young age. Health-related quality of life (HRQOL) is thought to be diminished due to visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, few studies have identified variables associated with HRQOL among those with RB. Purpose: To compare HRQOL of adolescents and young adults (AYAs) with RB to matched controls and to identify predictors of HRQOL in RB survivors. Methods: Using a cross-sectional design, 198 AYAs (101 RBs and 97 controls) completed HRQOL (PROMIS®-29 profile) and psychosocial questionnaires (Rosenberg self-esteem scale, multidimensional scale of perceived social support, and Hollingshead index for socioeconomic status). Clinical variables (age at diagnosis, visual acuity, laterality, heredity, treatment regime, and anesthesia exposure) were extracted from the medical record. Correlates of HRQOL were estimated using linear regression models. Results: RB survivors reported similar HRQOL compared to controls. Physical function (p < .001), social support (p = .013), and self-esteem (p = .028) were lower in the RB group compared to controls. Visual acuity and self-esteem accounted for 52% of the variance in PROMIS physical health summary scores and self-esteem accounted for 38% of the variance in mental health summary scores. Conclusion: Despite deficits in physical function and self-esteem HRQOL in RB survivors was comparable to healthy counterparts. However, the majority of RB survivors in this study had normal visual acuity. Clinicians should explore ways to enhance self-esteem in RB survivors.
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Affiliation(s)
| | | | | | - Jonathan W. Kim
- Children’s Hospital, Los Angeles, CA, USA
- USC Roski Eye Institute, University of Southern California, Los
Angeles, CA, USA
| | - Ron D. Hays
- University of California, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Nancy A. Pike
- Children’s Hospital, Los Angeles, CA, USA
- University of California, Los Angeles, CA, USA
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Knight LS, Ridge B, Staffieri SE, Craig JE, Senthil MP, Souzeau E. The caregiver experience in childhood glaucoma: An interview study. Ophthalmol Glaucoma 2022; 5:531-543. [PMID: 35151897 DOI: 10.1016/j.ogla.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate and report on the quality of life (QoL) issues experienced by caregivers of individuals with childhood glaucoma. DESIGN Exploratory qualitative study PARTICIPANTS: Thirty-five caregivers of individuals with childhood glaucoma (defined as disease onset <18 years) recruited from the Australian and New Zealand Registry of Advanced Glaucoma. METHODS A qualitative research methodology (interpretive phenomenology) was applied. Data were collected through semi-structured in-depth interviews. NVivo-12 software (QSR International Pty Ltd) was used to inductively analyze, code, and organize data into QoL themes. MAIN OUTCOME MEASURES Quality of life themes and their sub-themes. RESULTS The mean caregiver age was 50.2 ± 13.6 years and 27/35 (77%) were mothers of an individual with childhood glaucoma. A total of six QoL themes were identified. Coping strategies and emotional well-being were the most prominent themes. Caregivers frequently adopted problem-focused adaptive coping strategies including partner and/or peer support and normalization. A caregivers' psychosocial well-being was often impacted by feelings of guilt and regret regarding their child's delayed diagnosis, fear and anxiety related to medical and social support, and loss of control as their child developed medical autonomy. The effect of family planning from the perspective of the caregiver formed a novel QoL theme and was associated with normalization and parental confidence in management of the condition. CONCLUSION Childhood glaucoma poses a substantial threat to a caregivers' psychosocial well-being. Strategies which promote normalization, peer support, psychotherapeutic intervention and genetic counseling may be indicated and indeed critical to the caregiver as they adapt to supporting their child with glaucoma.
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Affiliation(s)
- Lachlan Sw Knight
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia; Department of Ophthalmology, Women's and Children's Hospital, North Adelaide, Australia.
| | - Bronwyn Ridge
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Sandra E Staffieri
- Department of Ophthalmology, Royal Children's Hospital, Parkville, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, University of Melbourne, Department of Surgery, Parkville, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
| | - Mallika Prem Senthil
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Emmanuelle Souzeau
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
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Janic A, Vincent A, Stinson J, Dimaras H. Values of Retinoblastoma Survivors and Parents Regarding Treatment Outcomes: A Qualitative Study. JCO Oncol Pract 2022; 18:e1000-e1015. [PMID: 34985991 DOI: 10.1200/op.21.00474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retinoblastoma is an aggressive pediatric eye cancer. Patient-reported outcome measures reveal important insights into how patients perceive their own health. Currently, there is no widely used or validated measure for assessment of retinoblastoma outcomes. The purpose of this research was to uncover which treatment outcomes that retinoblastoma survivors and their parents value, to inform the development of a future measure. METHODS This qualitative, cross-sectional study included retinoblastoma survivors age 6 years and older and parents of retinoblastoma survivors. Participants who did not demonstrate fluency in English were excluded. Study participants participated in semistructured interviews or focus groups, either in person at The Hospital for Sick Children, Toronto, Canada, or through secure videoconference, between March 3, 2019, and January 25, 2020. Iterative rounds of opening coding, codebook development, and coresearcher analysis were used to identify key emergent themes and subthemes. RESULTS Seventeen adults participated in six focus groups. Nine pediatric survivors participated in individual interviews. Four common themes emerged from all participant groups: (1) definition of treatment success, (2) enucleation-acceptance and challenges, (3) treatment outcomes to measure, and (4) need for outcome reporting. An additional, unique theme was identified in all pediatric discussions: worries and coping mechanisms. Treatment outcomes deemed valuable were related to the following domains: psychosocial outcomes, daily functioning, functional vision, retinoblastoma education, cosmetic outcomes, and secondary eye conditions. CONCLUSION This study represents the first stage in the development of a retinoblastoma-specific patient-reported outcome measure. The findings reveal insight into what outcomes are valued by survivors after treatment and offer promise to improve outcomes assessment for retinoblastoma.
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Affiliation(s)
- Ana Janic
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
| | - Ajoy Vincent
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.,Genetics and Genome Biology, SickKids Research Institute, Toronto, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.,Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada.,The Centre for Global Child Health, SickKids Research Institute, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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10
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El Hage S, Wakim E, Daou L, El Masri J, Salameh P. Epidemiology and Incidence of Retinoblastoma in the Middle East: A Nationwide Study in Lebanon. Cureus 2021; 13:e18696. [PMID: 34790455 PMCID: PMC8584182 DOI: 10.7759/cureus.18696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Retinoblastoma, although a rare pediatric cancer, can lead to disastrous outcomes if not managed early. This mishap often happens in developing countries. Conversely, early diagnosis and treatment of retinoblastoma in developed countries were associated with a surge in RB1 gene carriers. Aim: The authors aimed to evaluate the incidence of retinoblastoma in the Lebanese population aged between 0 and 19 years according to age, sex, and other variables and compare the age-standardized incidence rates with regional and worldwide countries. Methods: Data were retrieved from the National Cancer Registry (NCR) of the Ministry of Public Health (MOPH). Subsequently, incidence rates, age-standardized rates, and fictional incidence rates excluding the emigrant population were calculated. Retinoblastoma trends were found using the Joinpoint regression program software. Results: From the 38 cases of retinoblastoma recorded in the nine years cohort, 29 cases occurred in the 0-4 age group, and age-standardized rates were 2.8 and 3.6 per million person-years for the 0-19 and 0-14 age groups, respectively. When the refugee population was excluded, the ASR 0-19 almost doubled from 2.8 per million person-years to 5.16 per million person-years. Joinpoint regression revealed that retinoblastoma trends were divided into two segments showing a decrease from 2005 until 2011 and a rising trend in 2011-2015. When compared to other countries in the region, Lebanon had low-intermediate 0-19 ASRs. Conclusion: Retinoblastoma incidence in Lebanon is in the lower margin of the worldwide average and could be underestimated due to the underdiagnosis in the refugee population. Efforts are being deployed to overcome the financial barriers in the treatment of retinoblastoma by coordinating with neighboring Arab countries.
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Affiliation(s)
- Said El Hage
- General Medicine, Lebanese University, Beirut, LBN.,Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Elyas Wakim
- Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Lea Daou
- Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Jad El Masri
- Neurosciences Research Center, Lebanese University, Beirut, LBN.,General Medicine, Lebanese University, Beirut, LBN.,Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Pascale Salameh
- Public Health, National Institute of Public Health, Clinical Epidemiology and Toxicology (INSPECT-LB), Beirut, LBN.,Public Health, University of Nicosia Medical School, Nicosia, CYP.,Pharmacy, Lebanese University, Beirut, LBN
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11
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Gregersen PA, Funding M, Alsner J, Olsen MH, Overgaard J, Urbak SF, Staffieri SE, Lou S. Living with heritable retinoblastoma and the perceived role of regular follow-up at a retinoblastoma survivorship clinic: 'That is exactly what I have been missing'. BMJ Open Ophthalmol 2021; 6:e000760. [PMID: 34568581 PMCID: PMC8438830 DOI: 10.1136/bmjophth-2021-000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To explore living with heritable retinoblastoma, specifically survivors’ perceived role of regular follow-up at a retinoblastoma survivorship clinic. Methods and analysis Adult survivors of heritable retinoblastoma were recruited from the Retinoblastoma Survivorship Clinic, Aarhus University Hospital. Ten survivors participated in individual explorative, semistructured interviews. Thematic data analysis was conducted. Results Five key themes relating to vision, social life, family, second cancer risk and the healthcare system were identified. Subthemes relating to the Retinoblastoma Survivorship Clinic included the retinoblastoma coordinator, cancer risk, psychosocial support and genetic knowledge. The retinoblastoma-related physical and psychosocial issues influenced survivors’ everyday living; however, the opportunity to live a normal life varied considerably, with the majority experiencing no major limitations. The need for specialised management and a coordinator was emphasised to be the main value of the Retinoblastoma Survivorship Clinic. Conclusion Despite reporting an overall normal life and no major limitations in daily living activities, our data confirm that heritable retinoblastoma impacts several aspects of daily living. Uniquely, this study demonstrates that the main value of the Retinoblastoma Survivorship Clinic was a specialised contact person and coordinator in the healthcare system, providing continuous and necessary management and guidance after retinoblastoma treatment, and for all aspects of health related to heritable retinoblastoma. The needs of heritable retinoblastoma survivors are complex and extensive, and the specific role of the healthcare system to support survivorship should be prioritised, specialised and multidisciplinary.
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Affiliation(s)
- Pernille Axel Gregersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Centre for Rare Disorders, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Funding
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Maja H Olsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Steen F Urbak
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra E Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stina Lou
- Defactum - Public Health & Health Services Research, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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12
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Quality of Life in Adults with Childhood Glaucoma: An Interview Study. Ophthalmol Glaucoma 2021; 5:325-336. [PMID: 34562634 DOI: 10.1016/j.ogla.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/25/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore and report on the quality-of-life (QoL) issues encountered by adults with childhood glaucoma. DESIGN Exploratory qualitative study. PARTICIPANTS Forty-seven participants with childhood glaucoma (defined as disease onset <18 years) recruited from the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG). METHODS A qualitative research methodology (interpretive phenomenology) was applied, and data were collected through semistructured in-depth interviews. NVivo-12 software (QSR International Pty Ltd) was used to inductively analyze and code data to identify QoL themes pertinent to the cohort studied. MAIN OUTCOME MEASURES Quality-of-life themes and subthemes. RESULTS Mean participant age was 40.0 ± 15.3 years, and 55% of participants were female. We identified 10 QoL themes pertinent to adults living with childhood glaucoma. Coping strategies and emotional well-being were the most prominent themes. Maladaptive coping strategies, including treatment nonadherence, were observed more commonly in individuals aged <40 years and those without a vision impairment or reviewed less regularly. Emotional well-being was affected by feelings of being misunderstood because of the rarity of the condition, being self-conscious of physical manifestations of the disease, and anxiety related to possible disease progression and vision loss. The effect of childhood glaucoma on family planning formed a novel QoL theme and included worry for their child to inherit the condition and an inability to fulfill parental duties. This often led to genetic counseling-seeking behaviors. Mobility issues were infrequently experienced. CONCLUSIONS Childhood glaucoma poses a substantial impact to the emotional well-being of adults with the condition, which is mediated by the use of coping strategies. Genetic counseling and family planning options may be important. This study supports the development of a childhood glaucoma-specific patient-reported outcome measure for assessment of the psychosocial impact of childhood glaucoma in adults.
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13
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Willard VW, Qaddoumi I, Pan H, Hsu CW, Brennan RC, Wilson MW, Rodriguez-Galindo C, Goode K, Parris K, Phipps S. Cognitive and Adaptive Functioning in Youth With Retinoblastoma: A Longitudinal Investigation Through 10 Years of Age. J Clin Oncol 2021; 39:2676-2684. [PMID: 33891476 DOI: 10.1200/jco.20.03422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To describe the trajectory of cognitive and adaptive functioning in pediatric patients with retinoblastoma from diagnosis through age 10. This is an extension of a previous report that discussed findings from diagnosis through age 5. PATIENTS AND METHODS Ninety-eight participants with retinoblastoma completed psychological assessments as part of their enrollment on an institutional treatment protocol, with 73 completing an additional assessment at age 10. Trajectories of adaptive and cognitive functioning were determined, with data analyzed by treatment strata, and patients with 13q- analyzed separately. RESULTS Longitudinal trajectories identified a significant change point in trends at age 5, with functioning declining from diagnosis through age 5 and then increasing from age 5 to age 10. This pattern was observed for all strata for adaptive functioning, but only for enucleation-only patients (strata C low) for cognitive functioning. Cognitive trajectories were also influenced by laterality and enucleation status. At age 10, overall functioning was generally within the average range, although estimated intelligence quotient was significantly below the normative mean for enucleation-only (C low) patients. Patients with 13q- demonstrated very low functioning, but few analyses were significant because of small sample size. CONCLUSION The results generally indicate that previously demonstrated declines in functioning from diagnosis through age 5 improve by age 10. However, these early declines, as well as the continuous difficulties observed in patients treated with enucleation only, suggest the need for early intervention services for young patients with retinoblastoma. Continuous monitoring of the psychological functioning of patients with retinoblastoma, increased awareness of risk factors such as unilateral disease, enucleation, race, and surgery-only treatment plans, and referral to Early Intervention for all patients are indicated.
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Affiliation(s)
- Victoria W Willard
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Ibrahim Qaddoumi
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Haitao Pan
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Chia-Wei Hsu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
| | - Rachel C Brennan
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Matthew W Wilson
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN.,Department of Ophthalmology, University of Tennessee, Memphis, TN
| | - Carlos Rodriguez-Galindo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN.,Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Kristin Goode
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Kendra Parris
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St Jude Children's Research Hospital, Memphis, TN
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14
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Abstract
Retinoblastoma is the most common ocular malignancy of childhood. With an estimated 300 cases annually in the United States, retinoblastoma is nevertheless considered a rare tumor. Although retinoblastoma primarily affects younger children, diagnosis during the neonatal age range is less common. However, an understanding of patients at risk is critical for appropriate screening. Early detection and treatment by a multidisciplinary specialty team maximizes the chance for survival and ocular/vision salvage while minimizing treatment-related toxicity. Testing for alterations in the RB1 gene has become standard practice, and informs screening and genetic counseling recommendations for patients and their families.
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15
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Abstract
Retinoblastoma is a rare malignancy of the eye affecting children, most commonly four years old and younger. Although chemotherapy and radiation treatment aim to spare the eye, in some cases, enucleation (ie, removal of the eye) is required to prevent cancer metastases or recurrence. Enucleation procedures are primarily performed at specialty institutions and may involve the surgical placement of an implant in the orbit of the eye. Unique perioperative considerations are required because of the age of the child at the time of the diagnosis and procedure and the involvement of a parent or caregiver who will be caring for the child postoperatively. This article presents an overview of retinoblastoma and enucleation and discusses the care and management of the unique patient population undergoing enucleation.
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16
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D'Amanda CS, Nolen R, Huryn LA, Turriff A. Psychosocial impacts of Mendelian eye conditions: A systematic literature review. Surv Ophthalmol 2020; 65:562-580. [DOI: 10.1016/j.survophthal.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 01/07/2023]
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Janic A, Bowden S, Levy S, Stinson J, Dimaras H. Patient-reported outcome measures for retinoblastoma: a scoping review. J Patient Rep Outcomes 2020; 4:66. [PMID: 32770435 PMCID: PMC7415058 DOI: 10.1186/s41687-020-00232-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Retinoblastoma is a childhood retinal cancer with lifelong consequences such as vision loss and increased risk of second cancer. Patient-reported outcome measures (PROMs) are instruments that measure outcomes related to health directly reported by patients. The purpose of this study was to determine the scope, characteristics and quality of PROMs used in retinoblastoma and related fields of pediatric ophthalmology and pediatric oncology. METHODS Databases MEDLINE and Embase were searched for studies in the English language that reported on PROMs used in retinoblastoma, pediatric oncology, or pediatric ophthalmology; grey literature and studies reporting on developmental PROM phases were excluded. PROMs were grouped by the construct measured and domains assessed, and classified as condition-specific or generic. A subsequent search was then conducted in MEDLINE and Embase for studies assessing measurement properties of the identified PROMs. PROMs with associated studies were assessed for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy. RESULTS Among 110 eligible studies uncovered by the database searches, 143 PROMs were identified: one retinoblastoma-specific, 56 ophthalmology- and 86 oncology-related. The most common construct measured was 'health-related quality of life' and the most common domain assessed was emotional well-being. Of the 143 PROMs, 100 had associated validation studies; the one retinoblastoma-specific PROM was not validated. Quality assessment revealed 34/100 PROMs received a score of sufficient quality in both subcategories of 'overall content validity'; 3/100 received a score of sufficient quality in both subcategories of 'internal structure'; 0/100 received a score of sufficient quality in all three subcategories of 'remaining measurement properties'. The Patient-Reported Outcome Measure Information System (PROMIS) Pediatric Profile-25 was the highest-scoring PROM identified, meeting COSMIN standards for 2/3 measurement property categories (and 5/7 subcategories). Eleven additional PROMs were identified which had sufficient scores in 1/3 measurement property categories (and 5/7 subcategories). CONCLUSION The study identified several PROMs from the pediatric ophthalmology and pediatric oncology literature that could be relevant to the retinoblastoma population, but many have limits to their validation. Future development of a retinoblastoma-specific PROM, performed in partnership with retinoblastoma patients to support optimal content validity, could first focus on the selection and definition of the optimal construct to measure, followed potentially by adaptation and further validation of the relevant PROMs with strong methodologic quality identified in this study.
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Affiliation(s)
- Ana Janic
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
| | - Sylvie Bowden
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
| | - Sarah Levy
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, M5T 1P8, Canada
| | - Helen Dimaras
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 2R3, Canada.
- Child Health Evaluative Sciences Program, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada.
- The Centre for Global Child Health, SickKids Research Institute, 686 Bay Street, Toronto, M5G 0A4, Canada.
- Division of Clinical Public Health, University of Toronto, 150 College Street, Toronto, M5T 3M7, Canada.
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18
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Barrett PM, Mullen L, McCarthy T. Enduring psychological impact of childhood cancer on survivors and their families in Ireland: A national qualitative study. Eur J Cancer Care (Engl) 2020; 29:e13257. [PMID: 32537764 PMCID: PMC7988562 DOI: 10.1111/ecc.13257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/30/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
Objective To establish the major expressed psychological needs of adult survivors of childhood cancer living in Ireland. Methods Seven focus groups were conducted with adult survivors of childhood cancer and their parents in 2018. Survivors were invited to participate if they were diagnosed with cancer before age 18. Results Thirty‐three participants (15 survivors, 18 parents; 27 female, 6 male) were included. They had experienced a range of haematological and solid tumours. Five themes were generated: (a) Enduring psychological impact on survivors; many survivors experience delayed trauma and mental health crises in adulthood. (b) Enduring psychological impact on family members; parents and siblings have unmet psychological needs relating to the family's experience of cancer. (c) Enduring impact on family dynamics; survivors and parents expressed fear and guilt relating to cancer which impacted on family interactions. (d) Challenges accessing support; psychological support services are inadequate to meet expressed needs. (e) Desired model of care; no single service model appeals to all survivors, and flexibility is required in the delivery of psychological support. Conclusion Adult survivors of childhood cancer and their family members experience enduring psychological effects relating to their diagnosis and treatment. Psychological support services are inadequate to meet the expressed needs of this growing population.
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Affiliation(s)
- Peter M Barrett
- HSE National Cancer Control Programme, Dublin 1, Ireland.,School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,Wellcome Trust/HRB Irish Clinical Academic Training (ICAT) Programme, University College Cork, Cork, Ireland
| | - Louise Mullen
- HSE National Cancer Control Programme, Dublin 1, Ireland
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19
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Banerjee SC, Pottenger E, Petriccione M, Chou JF, Ford JS, Sklar CA, Robison LL, Kleinerman RA, Oeffinger KC, Francis JH, Abramson DH, Dunkel IJ, Friedman DN. Impact of enucleation on adult retinoblastoma survivors' quality of life: A qualitative study of survivors' perspectives. Palliat Support Care 2020; 18:322-331. [PMID: 31699178 PMCID: PMC7205583 DOI: 10.1017/s1478951519000920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Retinoblastoma is the most common primary intraocular tumor of childhood with >95% survival rates in the US. Traditional therapy for retinoblastoma often included enucleation (removal of the eye). While much is known about the visual, physical, and cognitive ramifications of enucleation, data are lacking about survivors' perception of how this treatment impacts overall quality of life. METHODS Qualitative analysis of an open-ended response describing how much the removal of an eye had affected retinoblastoma survivors' lives and in what ways in free text, narrative form. RESULTS Four hundred and four retinoblastoma survivors who had undergone enucleation (bilateral disease = 214; 52% female; mean age = 44, SD = 11) completed the survey. Survivors reported physical problems (n = 205, 50.7%), intrapersonal problems (n = 77, 19.1%), social and relational problems (n = 98, 24.3%), and affective problems (n = 34, 8.4%) at a mean of 42 years after diagnosis. Three key themes emerged from survivors' responses; specifically, they (1) continue to report physical and intrapersonal struggles with appearance and related self-consciousness due to appearance; (2) have multiple social and relational problems, with teasing and bullying being prominent problems; and (3) reported utilization of active coping strategies, including developing more acceptance and learning compensatory skills around activities of daily living. SIGNIFICANCE OF RESULTS This study suggests that adult retinoblastoma survivors treated with enucleation continue to struggle with a unique set of psychosocial problems. Future interventions can be designed to teach survivors more active coping skills (e.g., for appearance-related issues, vision-related issues, and teasing/bullying) to optimize survivors' long-term quality of life.
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Affiliation(s)
- Smita C. Banerjee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, NY, USA
| | - Charles A Sklar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | - David H Abramson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Danielle Novetsky Friedman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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20
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Quality of Life (QoL) and Psychosocial Outcomes in Adult Survivors of Unilateral Retinoblastoma (RB) in China. J Ophthalmol 2020; 2020:4384251. [PMID: 32280521 PMCID: PMC7125462 DOI: 10.1155/2020/4384251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess the quality of life (QoL) and the long-term psychosocial outcomes in adult survivors of unilateral retinoblastoma (RB). METHODS This is a cross-sectional study. Enrolment was offered to all adult survivors of unilateral RB who were treated by enucleation and were followed up in the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine; noncancer healthy adults served as a control group. All participants completed a series of questionnaires consisting of two aspects, QoL and psychosocial status. The psychosocial outcomes included anxiety, depression, fear of cancer, and satisfaction with facial appearance. RESULTS A total of 66 RB survivors (43.0% male) and 66 healthy adults (33.3% male) were aged 27.94 ± 7.63 and 29.18 ± 8.37 at the time of the study, respectively. Adult RB survivors did not have significantly higher rates of depression and anxiety compared with the control group, and they experienced a relatively good QoL. RB survivors were more likely to worry about their facial appearance (median, 1.59 [inter-quartile range, IQR, 1.27 to 2.16] v median, 0.36 [IQR, 0.09 to 1.18]; p < 0.001). Radiotherapy was not the factor affecting satisfaction with facial appearance (β, -0.27 [confidence interval, CI, -0.69 to 0.16]; p < 0.001). Radiotherapy was not the factor affecting satisfaction with facial appearance (p < 0.001). Radiotherapy was not the factor affecting satisfaction with facial appearance (p < 0.001). Radiotherapy was not the factor affecting satisfaction with facial appearance (. CONCLUSIONS Unilateral RB survivors are a fairly healthy and resilient group. Most unilateral RB survivors experience a relatively good QoL, and they do not have poorer psychosocial functioning compared with a noncancer sample. Females may need more specific psychosocial care.
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Flegg K, Gelkopf MJ, Johnson SA, Dimaras H. The top 10 retinoblastoma research priorities in Canada as determined by patients, clinicians and researchers: a patient-oriented priority-setting partnership. CMAJ Open 2020; 8:E420-E428. [PMID: 32518094 PMCID: PMC7286623 DOI: 10.9778/cmajo.20190221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Retinoblastoma is a childhood cancer of the eye that can have lifelong effects on patients and families. The purpose of this study was for people affected by retinoblastoma, clinicians and researchers to jointly determine the top 10 retinoblastoma research priorities in Canada. METHODS An adaptation of the James Lind Alliance Priority Setting Partnership (PSP) methodology was employed. People were invited to participate in any stage of the priority-setting process if they were a resident of Canada, and were a patient with retinoblastoma (or a family member or friend of someone diagnosed with retinoblastoma) or a clinician or researcher interested in retinoblastoma. Patients were full partners in study design and implementation, and result dissemination, through involvement in a national working group (1 patient and 9 nonpatients) and steering committee (4 patients and 11 nonpatients). In phase 1 of the study, participants responded to an online survey that asked, "What questions about retinoblastoma would you like to see answered by research?" In phase 2, the steering committee reviewed and refined the list of survey responses and decided on a list of 30 questions to be ranked by means of the nominal group technique in phase 3, a priority-setting workshop. RESULTS In total, 175 retinoblastoma research questions were suggested by 59 survey participants (38 patients and 21 nonpatients). The categories with the greatest number of questions were genetics and molecular (45 [25.7%]), second cancer (29 [16.6%]) and psychosocial (27 [15.4%]). The top 10 questions as ranked by the workshop participants (10 patients and 10 nonpatients) fell into 7 categories: second cancer (2 questions), follow-up (2), psychosocial (2), treatment (1), diagnosis (1), global health (1) and miscellaneous (1). The early diagnosis of retinoblastoma was identified as the top retinoblastoma research priority in Canada. INTERPRETATION The list of priorities will serve as a resource for advocacy groups, research teams and funding agencies that focus on retinoblastoma. The inclusion of researchers as participants was an adaptation of the James Lind Alliance PSP methodology and enriched the research prioritization process.
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Affiliation(s)
- Kaitlyn Flegg
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Maxwell J Gelkopf
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Sarah A Johnson
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences (Flegg, Gelkopf, Dimaras), The Hospital for Sick Children, Toronto, Ont.; Department of Neuroscience (Johnson), Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, Fla.; Department of Ophthalmology and Vision Sciences (Dimaras), Faculty of Medicine, and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program (Dimaras) and Centre for Global Child Health (Dimaras), SickKids Research Institute, Toronto, Ont.
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22
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Belson PJ, Eastwood JA, Brecht ML, Hays RD, Pike NA. A Review of Literature on Health-Related Quality of Life of Retinoblastoma Survivors. J Pediatr Oncol Nurs 2019; 37:116-127. [PMID: 31762375 DOI: 10.1177/1043454219888805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Retinoblastoma is a malignant tumor of the eye that typically presents in early childhood and occurs in approximately 1 in 20,000 births. While active treatment of the tumor is typically completed in childhood, survivors often suffer from long-term effects from treatment including visual impairment, facial deformities, and fear of recurrence or secondary cancer. However, little is known how these long-term effects affect their health-related quality of life (HRQOL). Purpose: To review the literature on HRQOL in retinoblastoma survivors. Method: We searched three electronic databases from January 2005 to December 2018 for original research articles reporting on HRQOL or individual domains such as function, cognition, and psychosocial outcomes in retinoblastoma survivors. Results: A total of 59 articles were reviewed and 15 were identified as eligible. Five of the studies reported worse HRQOL in retinoblastoma survivors than controls or general population norms. Parent-proxy ratings were worse than survivors' self-reports. Conclusion: Our findings confirm the need for further HRQOL research to assess the factors influencing long-term outcomes associated with treatment in adolescent and young adult retinoblastoma survivors. By identifying any potential deficits in specific domains of HRQOL, early interventions might be developed to improve HRQOL in retinoblastoma survivors.
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Affiliation(s)
- Paula J Belson
- University of California, Los Angeles, CA, USA.,Children's Hospital Los Angeles, CA, USA
| | | | | | - Ron D Hays
- University of California, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Nancy A Pike
- University of California, Los Angeles, CA, USA.,Children's Hospital Los Angeles, CA, USA
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23
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Depression, Anxiety, and Stress in Parents of Patients With Retinoblastoma. Am J Ophthalmol 2019; 207:130-143. [PMID: 31163135 DOI: 10.1016/j.ajo.2019.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/25/2019] [Accepted: 05/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess depression, anxiety, and stress in parents of patients with retinoblastoma and to evaluate the impact of unifocal vs multifocal retinoblastoma. METHODS A cross-sectional, self-reported psychological assessment of parents of patients with retinoblastoma at a tertiary care ocular oncology center was performed. The Beck Depression Inventory-II (BDI), Beck Anxiety Inventory (BAI), The Parental Stress Index 4-Short Form, and a retinoblastoma Knowledge Assessment questionnaire were administered. Descriptive statistics for outcomes and comparative analyses were made. RESULTS There were 138 parents of children with retinoblastoma (unifocal: n = 77, multifocal: n = 61). Overall, parents displayed mild, moderate, or severe depression (BDI) (n = 37, 26.7%); mild, moderate, or severe anxiety (BAI) (n = 49, 35.8%), and stress scores within normal limits (n = 138, 100%). A comparison (unifocal vs multifocal) revealed parents of children with multifocal retinoblastoma with severe depression (1.4% vs 10.2%, P < .02), and no differences in anxiety or stress. Factors associated with moderate or severe parental depression included previous history of depression (30.0% vs 3.9%, P < .001) and factors for moderate or severe anxiety included previous history of depression (33.3% vs 8.6%, P < .001), parent highest level of education at high school or less vs college or beyond (29.2% vs 10.9%, P = .031), and parental report of "child developmental delay" (31.5% vs 11.3%, P = .019). CONCLUSIONS The majority of parents displayed minimal depression (73.3%), anxiety (64.2%), or stress (100%). However, severe depression is more often found in those whose children have multifocal disease, and previous history of depression and less education can impact psychological function. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Friedman DN, Chou JF, Francis JH, Sklar CA, Li Y, McCabe M, Robison LL, Kleinerman RA, Oeffinger KC, Abramson DH, Dunkel IJ, Ford JS. Vision-Targeted Health-Related Quality of Life in Adult Survivors of Retinoblastoma. JAMA Ophthalmol 2019; 136:637-641. [PMID: 29710339 DOI: 10.1001/jamaophthalmol.2018.1082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Retinoblastoma survivors are at risk for adverse oculo-visual outcomes. Limited data are available regarding long-term vision-targeted health-related quality of life (HRQoL) of adult retinoblastoma survivors. Objective To examine vision-targeted HRQoL as reported on the 25-item National Eye Institute Visual Field Questionnaire for overall and specific scale scores among adult survivors of retinoblastoma. Design, Setting, and Participants The Retinoblastoma Survivor Study is a retrospective cohort of adult retinoblastoma survivors treated at 3 academic medical centers in New York between 1932 and 1994. Participants completed a comprehensive questionnaire between April 2008 and June 2010. Items were scored in January 2013 and preliminary analyses were performed in July 2015. Models were finalized in May 2017. Main Outcomes and Measures Self-reported vision-targeted HRQoL as reported on the 25-item National Eye Institute Visual Field Questionnaire. Items are scored from 0 to 100, with 100 representing the highest quality of life. Results Among 470 adult retinoblastoma survivors (53.6% with bilateral disease; 52.1% female; 86.4% white and non-Hispanic; mean age at study, 43.3 years; range, 18.0-77.0 years), 86% had at least 1 eye removed (1 eye, 74.5%; both eyes, 11.5%); 56.5% were previously treated with radiotherapy; and 61.3% rated their eyesight as excellent/good while 16.2% reported complete blindness. The overall mean (SD) VFQ composite score for all survivors was 81.1 (17.2) (mean [SD] score for unilateral retinoblastoma survivors, 91.4 [7.7]; bilateral retinoblastoma survivors, 72.3 [18.2]; difference between survivors with unilateral and bilateral disease, 19.1 [95% CI, 16.5-21.7; P < .001]). Prior exposure to radiotherapy was not associated with decreased overall VFQ (β = -0.08; 95% CI, -0.15 to 0.002; P = .06) but was related to a few specific subdomains of visual functioning. Conclusions and Relevance These findings suggest retinoblastoma-related oculo-visual problems are associated with functional status and vision-targeted HRQoL of adult survivors, particularly among those with bilateral disease.
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Affiliation(s)
- Danielle Novetsky Friedman
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Charles A Sklar
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mary McCabe
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ruth A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland
| | | | - David H Abramson
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Jennifer S Ford
- Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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Ziolkowski N, Kitto SC, Jeong D, Zuccaro J, Adams-Webber T, Miroshnychenko A, Fish JS. Psychosocial and quality of life impact of scars in the surgical, traumatic and burn populations: a scoping review protocol. BMJ Open 2019; 9:e021289. [PMID: 31164358 PMCID: PMC6561410 DOI: 10.1136/bmjopen-2017-021289] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Despite the fact that millions of scars affect individuals annually, little is known about their psychosocial impact and overall quality of life (QOL) on individuals. Scars from multiple aetiologies may cause psychiatric and emotional disturbances, can limit physical functioning and increase costs to the healthcare system. The purpose of this protocol is to describe the methodological considerations that will guide the completion of a scoping review that will summarise the extent, range and nature of psychosocial health outcomes and QOL of scars of all aetiologies. METHODS AND ANALYSIS A modified Arksey and O'Malley (2005) framework will be completed, namely having ongoing consultation between experts from the beginning of the process, then (1) identifying the research question/s, (2) identifying the relevant studies from electronic databases and grey literature, with (3) study selection and (4) charting of data by two independent coders, and (5) collating, summarising and reporting data. Experts will include a health information specialist (TAW), scar expert (JSF), scoping review consultant (SCK), as well as at least two independent coders (NZ, AM). ETHICS AND DISSEMINATION Ethics approval will not be sought for this scoping review. We plan to disseminate this research through publications, presentations and meetings with relevant stakeholders.
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Affiliation(s)
- Natalia Ziolkowski
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Simon C Kitto
- Department of Innovation in Medical Education and Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dahn Jeong
- Department of Innovation in Medical Education and Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Zuccaro
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomasin Adams-Webber
- Hospital Library and Archives, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anna Miroshnychenko
- Department of Life Sciences, Faculty of Science Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Joel S Fish
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Enucleations and Eviscerations for Combat Ocular Trauma Performed During Operations Iraqi and Enduring Freedom: 2001 to 2011. J Craniofac Surg 2019; 30:767-770. [PMID: 30817532 DOI: 10.1097/scs.0000000000005294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe the demographics and clinical outcomes of patients who underwent posttraumatic enucleation or evisceration during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) from 2001 to 2011. METHODS The Walter Reed Ocular Trauma Database is a retrospective case series of US Servicemembers and Department of Defense civilians who had combat ocular injuries in OIF and OEF. Data regarding posttraumatic enucleations and eviscerations performed during OIF and OEF were extracted. The main outcomes analyzed were the number of enucleations and eviscerations performed, location of the surgery, laterality, and graft type. The secondary outcome measures included: mechanism of injury and Ocular Trauma Score classification. RESULTS One hundred nine enucleations and eviscerations were performed on the 890 eyes (12.24%). Sixty-three (57.80%) primary enucleations, 36 (33.03%) secondary enucleations, 5 (4.59%) postretinal detachment repair enucleations, and 5 (4.59%) primary eviscerations were completed. The surgeries were completed at a combat support hospital (57; 52.3%), or Walter Reed Army Medical Center (49; 45.0%). All surgeries were unilateral except in 2 patients. The most common graft type used was silicone (n = 56; 51.38%). Improvised explosive devices caused 76 (69.72%) eye injuries. Ocular Trauma Score were recorded as 56 (51.38%) between 0 and 44, 44 (40.37%) between 45 and 65, and unknown in 9 (8.26%). CONCLUSION Posttraumatic enucleation or evisceration due to devastating ocular trauma is required in about 15% of ophthalmic patients in modern combat trauma. The psychosocial impact on veterans who have required an enucleation or evisceration from combat trauma has been poorly studied and requires further review.
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Ahomäki R, Kero A, Koivisto M, Madanat-Harjuoja L, Malila N, Lähteenmäki PM. Purchases of antidepressants after cancer at a young age in Finland. Int J Cancer 2018; 144:1227-1233. [PMID: 30357818 DOI: 10.1002/ijc.31942] [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] [Received: 04/24/2018] [Revised: 09/05/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022]
Abstract
According to previous studies, childhood cancer survivors have an elevated risk for late mental health effects. However, only few studies exist on young adulthood (YA) cancer survivors' mental health outcomes. In our study, we examined first time antidepressant (AD) medication purchases of childhood and YA cancer patients compared to siblings. The first time AD medication purchases of 7,093 cancer patients aged 0-34 years at diagnosis and a sibling cohort (N = 26,882) were retrieved from the Social Insurance Institution of Finland (Kela) since 1.1.1993. Cancer patients diagnosed between 1.1.1994 and 31.12.2004 were identified from the Finnish Cancer Registry and sibling controls via the Population Registry Centre. Statistical analyses were performed via the Cox regression model, and the hazard ratios (HR) were adjusted for age and gender. Increased hazard ratios for AD purchases were found in the younger (0-19 years at cancer diagnosis) [HR 5.2, 95%CI (3.7-7.2)] and older (age 20-34 years at cancer diagnosis) [HR 4.5, 95%CI (3.9-5.2)] cancer patient groups compared to siblings. The gender effect was similar in patients and controls, showing that females have higher risk for AD purchases than males. Males in the younger patient group had highest HR (5.6) for AD purchases compared to siblings. Patients with sarcoma or CNS tumor in the younger age group and leukemia or CNS malignancy in the older age group had the highest risk for AD medication purchases. The frequency and risk for AD purchases has been increasing during recent decades in both cancer patient age groups compared to siblings. Thus, cancer patients' psychological support should be properly assessed already after primary treatment. Certain diagnostic groups as well as female patients may require more psychological support than others.
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Affiliation(s)
- Ritva Ahomäki
- Turku University Hospital, Department of Pediatrics and Adolescent Medicine, and Turku University, Turku, Finland
| | - Andreina Kero
- Turku University Hospital, Department of Pediatrics and Adolescent Medicine, and Turku University, Turku, Finland
| | - Mari Koivisto
- University of Turku, Department of Biostatistics, Turku, Finland
| | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| | - Päivi M Lähteenmäki
- Turku University Hospital, Department of Pediatrics and Adolescent Medicine, and Turku University, Turku, Finland
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Kenney LB, Antal Z, Ginsberg JP, Hoppe BS, Bober SL, Yu RN, Constine LS, van Santen HM, Skinner R, Green DM. Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research. J Clin Oncol 2018; 36:2160-2168. [PMID: 29874140 DOI: 10.1200/jco.2017.76.3839] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.
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Affiliation(s)
- Lisa B Kenney
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Zoltan Antal
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Jill P Ginsberg
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Bradford S Hoppe
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Sharon L Bober
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Richard N Yu
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Louis S Constine
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Hanneke M van Santen
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Roderick Skinner
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Daniel M Green
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
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Long KA, Lehmann V, Gerhardt CA, Carpenter AL, Marsland AL, Alderfer MA. Psychosocial functioning and risk factors among siblings of children with cancer: An updated systematic review. Psychooncology 2018; 27:1467-1479. [DOI: 10.1002/pon.4669] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Vicky Lehmann
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | - Cynthia A. Gerhardt
- Department of Pediatrics and Psychology; Ohio State University; Columbus OH USA
- Center for Biobehavioral Health Research Institute at Nationwide Children's Hospital; Columbus OH USA
| | | | | | - Melissa A. Alderfer
- Nemours Children's Health System/A.I. duPont Hospital for Children; Wilmington DE USA
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia PA USA
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30
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Friend AJ, Feltbower RG, Hughes EJ, Dye KP, Glaser AW. Mental health of long‐term survivors of childhood and young adult cancer: A systematic review. Int J Cancer 2018; 143:1279-1286. [DOI: 10.1002/ijc.31337] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Amanda J. Friend
- School of MedicineUniversity of LeedsLeeds United Kingdom
- Leeds Institute of Data Analytics, University of LeedsLeeds United Kingdom
- Leeds Institute for Cancer and Pathology, University of LeedsLeeds United Kingdom
- Department of Paediatric OncologyLeeds Children's Hospital, Clarendon Wing, Leeds General InfirmaryLeeds United Kingdom
| | - Richard G. Feltbower
- School of MedicineUniversity of LeedsLeeds United Kingdom
- Leeds Institute of Data Analytics, University of LeedsLeeds United Kingdom
| | - Emily J. Hughes
- School of MedicineUniversity of SouthamptonSouthampton United Kingdom
| | - Kristian P. Dye
- Department of AnaestheticsYork Teaching Hospitals NHS TrustYork United Kingdom
| | - Adam W Glaser
- School of MedicineUniversity of LeedsLeeds United Kingdom
- Leeds Institute of Data Analytics, University of LeedsLeeds United Kingdom
- Leeds Institute for Cancer and Pathology, University of LeedsLeeds United Kingdom
- Department of Paediatric OncologyLeeds Children's Hospital, Clarendon Wing, Leeds General InfirmaryLeeds United Kingdom
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Denlinger CS, Ligibel JA, Are M, Baker KS, Broderick G, Demark-Wahnefried W, Friedman DL, Goldman M, Jones LW, King A, Ku GH, Kvale E, Langbaum TS, McCabe MS, Melisko M, Montoya JG, Mooney K, Morgan MA, Moslehi JJ, O'Connor T, Overholser L, Paskett ED, Peppercorn J, Rodriguez MA, Ruddy KJ, Sanft T, Silverman P, Smith S, Syrjala KL, Urba SG, Wakabayashi MT, Zee P, McMillian NR, Freedman-Cass DA. NCCN Guidelines Insights: Survivorship, Version 1.2016. J Natl Compr Canc Netw 2017; 14:715-24. [PMID: 27283164 DOI: 10.6004/jnccn.2016.0073] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment. They are intended to aid health care professionals who work with survivors of adult-onset cancer in the posttreatment period, including those in general oncology, specialty cancer survivor clinics, and primary care practices. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors. This article summarizes the NCCN Survivorship panel's discussions for the 2016 update of the guidelines regarding the management of anxiety, depression, posttraumatic stress disorder-related symptoms, and emotional distress in survivors.
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Affiliation(s)
| | | | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | - Mindy Goldman
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Allison King
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Elizabeth Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | - Kathi Mooney
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute
| | | | | | | | - Tara Sanft
- Yale Cancer Center/Smilow Cancer Hospital
| | - Paula Silverman
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Susan G Urba
- University of Michigan Comprehensive Cancer Center
| | | | - Phyllis Zee
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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32
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McNeill NA, Kors WA, Bosscha MI, van Dijk J, Fabius AWM, Houffelaar T, Verdonck-de Leeuw IM, Moll AC. Feasibility of RetinoQuest: e-health application to facilitate and improve additional care for retinoblastoma survivors. J Cancer Surviv 2017; 11:683-690. [PMID: 28948437 PMCID: PMC5671548 DOI: 10.1007/s11764-017-0642-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 07/06/2017] [Indexed: 10/24/2022]
Abstract
PURPOSE The current study aimed to evaluate the feasibility of RetinoQuest in clinical practice, from survivors and healthcare professionals' (HCPs) point of view. METHODS RetinoQuest is a touch screen computer program to monitor health-related quality of life (HRQoL) of retinoblastoma survivors via patient-reported outcome measures (PROMs) targeting children (4-10 years) as evaluated by their parents (proxy measures), adolescents (11-18 years), and adults. Feasibility was evaluated by the actual time taken to complete the PROMs, acceptability of the time as perceived by the users, the content of PROMs in RetinoQuest, and overall satisfaction with RetinoQuest. RESULTS Ninety-six survivors participated: 41 parents of children, 38 adolescents, and 17 adults. Mean time to complete the evaluation form was 7.8 min (median 6.7, range 2.4-24.5), and 90% of the users stated that the time needed to complete PROMs in RetinoQuest was acceptable. The majority of users reported that it was important to answer the questions (88% of the parents, 66% of the adolescents, and 76% of the adult survivors) and that all important issues were covered, e.g., no missing questions (78, 84, and 76%, respectively). Satisfaction rate was high, 7.8 according to parents, 8.1 according to adolescents, and 7.7 for adults. CONCLUSIONS RetinoQuest is a feasible e-health application to monitor HRQoL in retinoblastoma survivors in clinical practice. IMPLICATIONS FOR CANCER SURVIVORS This tool allows for open and structured communication which can lead to early detection of psychosocial impacts on quality of life and referral of the retinoblastoma survivors.
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Affiliation(s)
- Nuray A McNeill
- Department of Ophthalmology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Wijnanda A Kors
- Department of Pediatric Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Machteld I Bosscha
- Department of Ophthalmology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jennifer van Dijk
- Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Armida W M Fabius
- Department of Ophthalmology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Ton Houffelaar
- Department of Otolaryngology/Head & Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology/Head & Neck Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Clinical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Annette C Moll
- Department of Ophthalmology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Ophthalmology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Abstract
PURPOSE Proton radiotherapy (PRT) is used in the treatment of retinoblastoma (RB) and has the potential to minimize exposure of normal tissue to radiation and thus decrease risk of toxicity and second malignancies. However, comprehensive analyses of long-term patient outcomes are not available. METHODS RB patients treated with PRT at our institution between 1986 and 2012 were invited to return for participation in a study designed to assess long-term outcomes. Enrolled patients underwent comprehensive analysis including oncologic, ophthalmic, endocrine, cephalometric, and quality of life (QOL) assessments. RESULTS A total of 12 patients were enrolled in this study, and the average length of follow-up among enrolled patients was 12.9 years (range 4.8-22.2 years). All enrolled patients had bilateral disease, and the disease and visual outcomes for enrolled patients were similar to outcomes for all RB patients treated with PRT over the same time period at our institution. Endocrine evaluation revealed no growth abnormalities or hormonal deficiencies across the cohort. Based on MRI and external cephalometry, PRT was associated with less facial hypoplasia than enucleation. Patient and parent-proxy QOL assessments revealed that RB treatment did not appear to severely impact long-term QOL. CONCLUSIONS In addition to providing an opportunity for long-term disease control and functional eye preservation, PRT does not appear to be associated with unexpected late visual, endocrine, or QOL effects in this cohort.
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