Psychological Wellbeing in Adolescents with Leukaemia: A Comparative Study with Typical Development Peers

Exploration of Hope Among Young Adults with Cancer in Malaysia

Purpose: Hope is vital for cancer patients to cope with their illnesses. It is positively associated with better health outcomes, quality of life, and daily functioning. However, restoring hope after a cancer diagnosis can be challenging, especially for young adult cancer patients. This research aimed to investigate hope among young adults with cancer throughout their cancer experience and the exploration of hope preservation in these individuals. Methods: This qualitative study involved 14 young adults recruited from a closed Facebook group. The median age of the participants was 30.5 years (range 20-39 years), and their median survival year was 3 years (range 1-18 years from the date of diagnosis). Semistructured interviews and a thematic analysis were performed to identify the major themes that emerged from these interviews. Results: The findings identified that young adults expressed hopes for cancer advocacy, good physical and mental health, ease in the afterlife, and uncertain hopes due to thoughts of death. Three areas that influenced their hope are: (1) active hope with cancer peers; (2) cancer prognosis and hope; and (3) hope comes from prayer. Their cultural and religious beliefs influenced the various forms of hope and affected their experiences with cancer. In addition, this study discovered that not all positive communication with their physician resulted in hope. Conclusion: These findings provide important insight to health care professionals (HCPs) by encouraging young adults to discuss hope and improving the existing oncology social work-based intervention. This study suggests that hope is essential for chronic illness patients and should be supported continuously during and after treatments.

Prevalence of symptoms in children with acute lymphoblastic leukaemia: a systematic review and meta-analysis

BACKGROUND

Children with acute lymphoblastic leukaemia (ALL) experience multiple symptoms that occur in complicated patterns and negatively affect patient outcomes. To date, no systematic review has been performed on the prevalence of symptoms in children with ALL.

OBJECTIVE

The study aimed to report and analyse the prevalence of symptoms in children with ALL during treatment.

METHODS

A systematic search was conducted in eight databases (PubMed, Ovid Embase, Web of Science, CINAHL, PsycINFO, China WanFang Database, China Science and Technology Journal Database, and China National Knowledge Infrastructure) for studies published between January 1, 2000, and August 12, 2023. The methodological quality of the included studies was evaluated and a meta-analysis was performed to pool the prevalence of symptoms.

RESULTS

In total, 17 studies were included, from which 34 symptoms were identified. The symptom prevalence ranged between 1.5 and 91.0% and the most frequent symptoms observed were fatigue, lack of energy, dry mouth, lack of appetite, sweating, and feeling irritable, which occurred in at least 60% of the patients.

CONCLUSIONS

Symptoms remain highly prevalent in paediatric patients with ALL, which provides support for the need for symptom assessment in the clinical setting. Specific intervention is urgently needed to mitigate the symptoms in children with ALL and help them cope with the symptom burden.

Adolescents and young adults with oncohematological disease: use of social networks, impact of SARS-COV-2, and psychosocial well-being

Objective

Adolescents and young adults (AYA) with oncohematological diseases could have important psychosocial difficulties that could be worsened by the effects of the COVID19 pandemic. At this developmental stage, it is also important to assess the use of social networks (SNs). This study aims to investigate the type of social network use and the consequences of the COVID19 period. These patients are compared with matched healthy peers.

Methods

After the informant consent signature, the adolescents completed a series of self-report questionnaires on the use of SNs, on communication preferences, on social anxiety and on Covid19 impact through the online platform of LimeSurvey. Most of the adolescents belonged to the 18-20 age group (42.5%), were female (62%) and mainly off therapy (72%).

Results

Adolescents spent more than 2 h/day on Instagram and 1 h and half on Whatsapp, while Tik Tok use was on average 1 h/day, especially used by younger patients (r = -0.33, p = 0.023). Males used Twitch (t45 = -2.06, p = 0.05) and Youtube (t45 = -2.18, p = 0.03) for longer than females. AYA in therapy used more Tik Tok (U = 137.50; p = 0.03), Ask/Tellonym (U = 172.50; p = 0.05) and Twitch (U = 144; p = 0.017) than those off therapy. Healthy AYA showed lower levels of exposure (Z = -4.17; p = 0.00001) and impact (Z = -5.12; p = 0.00001) to Covid19, while the level of social anxiety is comparable and is in the normal range in both groups.

Discussion

Some clinical considerations and suggestions could be given based on these empirical results to health professionals in the care of AYA cancer patients.

Role of Peer Support in Posttraumatic Growth Among Adolescent and Young Adult Cancer Patients and Survivors

Purpose: Adolescents and young adults (AYA) who undergo cancer treatment sometimes report posttraumatic growth (PTG). Although the importance of peer support has been suggested, its association with PTG, especially its five distinct domains, needs to be investigated further in AYA cancer survivors. The present study examined the role of demographics and peer support in PTG among AYA cancer patients and survivors. Methods: The present, multicenter, cross-sectional, web-based study enrolled AYA cancer patients and survivors (median age: 28 years). Of 549 AYA patients recruited, 212 from 11 cancer centers and 12 cancer patient communities agreed to participate by completing a self-reported measure of PTG (Extended Version of the Posttraumatic Growth Inventory-Japanese) and providing information about their diagnosis, treatment, peer support (affiliation with an AYA patient community or friendship with other AYA patients), and social status. Multiple regression analysis was used to identify significant correlations overall and in the five PTG domains. Results: PTG was positively associated with male sex, having a confidant, and friendship with other AYA patients, and negatively associated with cranial radiation. Friendship with other AYA patients was positively associated with four of the five PTG subscales. For the five subscale scores, "cranial radiation" was negatively associated with "relating to others"; "belonging to a religion" was positively associated with "spiritual change"; and "having a confidant" was positively associated with "relating to others" and "new possibility." Conclusion: "Having a confidant" and "friendship with other AYA patients" were positively associated with PTG. Psychosocial interventions mobilizing peer support may contribute to promoting PTG in AYA patients. UMIN000035439.

Development and validation of a measure of adolescent and young adult goal-based quality of life (MAYA-GQOL)

PURPOSE

We developed and validated a measure assessing quality of life (QOL) through importance, attainability, and discrepancy of life goals among adolescents and young adults (AYA) with and without cancer. A specific goal-based QOL measure for AYA fills a critical gap in knowledge for AYA who are at a unique life stage, which may include shifts in priorities and goals.

METHODS

Through review of our existing AYA databases on goals, the literature, and cognitive interviews we developed the MAYA-GQOL. Items were administered to AYA with cancer (on/off treatment) (n = 124) and healthy AYA controls (n = 103) aged 15-29 years old. Psychometric analyses for comparison with existing QOL measures and discrepancies in perceived importance/attainability of goals were examined.

RESULTS

An item pool of 700 goals, based on prior research, was refined to 173 goals across nine categories: academic, administrative, body, health, job, leisure, interpersonal, intrapersonal, and religion. Validation between the MAYA-GQOL and existing QOL measures was supported. AYA survivors reported fewer overall current goals and fewer administrative, interpersonal, leisure, and religious goals. AYA survivors rated body goal importance significantly higher than healthy controls and intrapersonal goal importance significantly lower. Little discrepancy in importance and attainability across AYA was found.

CONCLUSIONS

The MAYA-GQOL represents an innovative way of measuring QOL among AYA by focusing on the relative importance, attainability, and discrepancy of developmentally appropriate goals. The MAYA-GQOL can identify areas of resilience and competence via assessment of important and attainable goals and can further assess how AYA with chronic illness are functioning relative to peers on goal domains relevant to the AYA developmental period.

The psychological, psychosocial and emotional wellbeing of children and young people with leukaemia

BACKGROUND

Leukaemia is the most common childhood cancer, and with the success of current treatment, it has an overall survival rate of up to 92%. Despite this, treatment does not come without consequences. As a result, it is no surprise that recent research has examined the long-term implications of this treatment.

METHODS

An integrative review was conducted to capture a broad range of primary research studies from both quantitative and qualitative perspectives. Four electronic databases were searched, displaying 3239 articles, of which nine met all the inclusion criteria. This integrative review explores these studies, using thematic analysis, with the purpose of identifying the impact this disease has on the psychological, psychosocial and emotional wellbeing of children and young people (CYP) diagnosed with leukaemia.

RESULTS

The review highlighted the vast impact that a leukaemia diagnosis can have on CYP and five main trends emerged: experienced emotions; relationships with peers; relationships with family; academic challenges; and differentiating factors.

DISCUSSION

As a result of the findings, it is recommended that CYP receive psychological support from diagnosis, with a regular reassessment throughout treatment. Parents and carers require support to enable them to efficiently care for their children. It is evident from this review that further research in this area would be beneficial to address some gaps in the literature.

Psychological Well-Being, Cognitive Functioning, and Quality of Life in 205 Adolescent and Young Adult Childhood Cancer Survivors Compared to Healthy Peers

The majority of the studies underlined how adolescent and young adult (AYA) Cancer Survivors had no significant differences in their well-being and quality of life compared with a control group of healthy counterparts, although French et al. (2013) found less years of education among cancer survivors. The present study aimed at comparing AYA cancer survivors and a control group of peers who had no history of serious illness, in terms of well-being, cognitive functioning, and perceptions of life. Participants in this study were 205 AYA cancer survivors, 126 males, off therapy from a mean of 10.87 years (SD = 4.91), with a mean age of 18.96 (SD = 3.08), recruited during follow-up visits and healthy counterparts (n = 205), matched for age and gender. They all completed self-report questionnaires: Ladder of Life, BSI-18 and Cognitive problems. Paired t test evidenced significant differences between survivors (Mean = 6.19; SD = 2.07) and controls (Mean = 6.88; SD = 2.02) in perceptions of quality of life regarding 5 years before the current time [t₍₂₀₄₎ = −3.39; p = 0.001], with a lower level for childhood cancer survivors. Specifically, Hierarchical regression (R² = 0.05, p = 0.04) identified a shorter time since the completion of treatment (β = 0.18, p = 0.03) and a trend of stem cell transplantation experience (β = −0.11, p = 0.06) as factors associated with negative perception of precedent quality of life. The AYA cancer survivors reported lower cognitive difficulties (Mean = 1.46) than controls (Mean = 1.56) [t₍₂₀₄₎ = −3.41; p = 0.001]: in memory (Mean_clinical = 1.32 vs Mean_control = 1.50) [t₍₂₀₄₎ = −4.52; p = 0.001], in concentration (Mean_clinical = 1.36 vs Mean_control = 1.54) [t₍₂₀₄₎ = −4.66; p = 0.001] and in mental organization skills (Mean_clinical = 1.47 vs Mean_control = 1.56) [t₍₂₀₄₎ = −2.56; p = 0.01], even if they had a lower educational attainment [X(9)2 = 131.28; p = 0.001]. They showed similar satisfaction with their psychological well-being and their lives as healthy counterparts, except for past life perceptions associated with the cancer period. Important recommendations for future research and clinical suggestions could be given.

Pain coping strategies in paediatric patients newly diagnosed with leukaemia compared with healthy peers

Objective

Children with leukaemia experience special difficulties adapting to stressful medical procedures and to the adverse effects of chemotherapy, though they can implement their coping strategies.

The aims of the study were to assess whether the coping‐with‐pain strategies could be influenced by a child's personal and illness factors and to render possible comparisons between children with leukaemia and healthy peers. Another aim was to compare parents' and children's reports on coping strategies.

Methods

A total of 125 patients (average age = 6.79 years; SD = 3.40) with acute leukaemia (lymphocytic leukaemia 90.4% and myeloid leukaemia 9.6%) and age‐matched healthy children with their parents were enrolled in the study. A socio‐demographic questionnaire and the Waldon–Varni Pediatric Pain Coping Inventory, parent and self‐report versions, were administered 1 month after diagnosis. Data regarding the therapy's side effects were recorded.

Results

The comparison between proxy‐reports of the two groups of parents found significant differences in terms of social support, self‐cognitive instructions and catastrophising strategies. Children aged 6–10 years relied more heavily on distraction than children of other ages, using more problem‐solving and self‐cognitive instructions. The results indicated moderate parent–child agreement.

Conclusion

Health professionals could help paediatric leukaemic patients in adopting more efficiently pain coping strategies applicable for different ages.

Posttraumatic stress symptoms in Chinese children with ongoing cancer treatment and their parents: Are they elevated relative to healthy comparisons?

OBJECTIVE

The objective of this work is to compare posttraumatic stress symptoms (PTSS) between families of children on cancer treatment and families of healthy children in China and to analyse the association among child PTSS, parent PTSS, and depression in the cancer group.

METHODS

Participants were children on cancer treatment (n = 91) and their parents (n = 91), and healthy children (n = 114) and their parents (n = 96). The children were asked to self-report PTSS, and the parents completed self-reported measures of PTSS and depression.

RESULTS

Although the prevalence of probable PTSD in children on cancer treatment was higher than that in comparisons (8.79% vs. 0.88%, P < 0.01), no statistic differences in PTSS levels were found between the two groups (P > 0.05). However, significant differences in PTSS levels and the prevalence of severe PTSS (21.98% vs. 1.04%) between parents of children with cancer and comparisons were observed (P < 0.001). Parent PTSS and depression were positively associated with child PTSS in the cancer group (P < 0.01).

CONCLUSION

The prevalence of probable PTSD in Chinese children with cancer was low, but PTSS was remarkably prevalent in their parents. Greater parent PTSS and depression were related to greater child PTSS. Results underline the importance to provide supportive psychological care for Chinese parents of children undergoing cancer treatment.

Influence of Gender and Self-Perceived Competence on Psychological Well-Being in Adolescent and Young Adult Cancer Survivors

Elucidating factors associated with mental health and well-being among adolescent and young adult cancer survivors (AYAs) is increasingly important as this population continues to grow. Adolescence and young adulthood are critical times for developing self-perceived competencies (SPCs), which may be shaped by the cancer experience and may have different consequences based on the person's gender. We assessed whether gender moderated the association between perceived competencies and mental health in 61 AYAs (51% males; 11-20 years old; diagnosed between 0.33 and 17.33 years old). Gender moderated the association of SPC in close friendship, job, and scholastic domains with depression, anxiety, and optimism.

Trajectories and risk factors for anxiety and depression in children and adolescents with cancer: A 1-year follow-up

BACKGROUND

There is limited data on the longitudinal trajectories of psychiatric disorders in children with cancer and risk factors for their persistence. The current study aimed to longitudinally assess the trajectories and risk factors for anxiety and depressive symptoms and disorders in children and adolescents with cancer.

METHODS

Children and adolescents with cancer and their parents completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety Module and were interviewed by the semi-structured Affective and Anxiety Modules of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), at 4 time points, 1, 4, 7, and 12 months following the diagnosis of cancer.

RESULTS

Of the 99 patients enrolled, 48% met criteria for anxiety and/or depressive disorders at least once during the follow-up period. There was a significant decrease in PROMIS pediatric and parent anxiety and depression scores (all p's < 0.01) and in the rate of depressive disorders over time (p = 0.02), while rates of anxiety disorders remained stable. Anxiety PROMIS pediatric and parent scores at baseline, having brain tumors and being in the acute treatment phase significantly predicted the presences of anxiety disorders at endpoint.

CONCLUSIONS

Our results highlight the importance of screening for anxiety and disorders in children with cancer, especially among those with brain tumors and at the acute phase of treatment.

Health Locus of Control in Parents of Children with Leukemia and Associations with Their Life Perceptions and Depression Symptomatology

In childhood cancer, parents have an important role in the promotion of their children's wellbeing and in their adoption of a locus of control style towards their children's health. The current study aimed at identifying types of locus of control in parents of children with leukemia and the possible association with depressive symptomatology and current life perception. One hundred and four parents were recruited at the Hematology-Oncology Clinic of the Department of Woman's and Child's Health, University of Padua, one month after a leukemia diagnosis. Participants were Caucasian with a mean age of 37.28 years (SD = 5.89), mostly mothers (87.5%) and with a mean of 12.16 years of education (SD = 3.82). After signing the informed consent, they filled in the Ladder of Life, the Brief Symptom Inventory-18 and the Parental Health Locus of Control (PHLOC) questionnaires. Paired-samples t-test (t = -14.42; df = 103; p = 0.0001) showed that parents of children with leukemia were more inclined to have an external locus of control than an internal one. The hierarchical regression analysis model (R² = 0.34; F = 4.32; p = 0.0001) identified health professional influence (ß = -0.28; p = 0.004), current life perception (ß = -0.3; p = 0.013) and future life perception (ß = -0.26; p = 0.012) as significant predictors of parental depression. Current life perception was best predicted (R² = 0.25; F = 3.96; p = 0.01) by the parental influence locus of control style (ß = 0.25; p = 0.03). Improving trust in the medical staff care and strengthening the internal locus of control in parents could be a preventive program to cope with parental depression symptomatology.