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Jong MC, Fernee CR, Stenling A, Lown EA, Berntsen S, Victorson DE, Jong M. Protocol of a randomised controlled multicentre trial investigating the effectiveness and safety of a wilderness programme on the mental and physical well-being of adolescents and young adults affected by cancer: the WAYA-2 study. BMJ Open 2024; 14:e087626. [PMID: 38772886 PMCID: PMC11110565 DOI: 10.1136/bmjopen-2024-087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Adolescents and young adults (AYAs) affected by cancer are an understudied group. Effective interventions are needed to support coping with the late effects of cancer, its treatment and to promote quality of life. Nature-based interventions may be promising in support of the self-management and health of AYAs affected by cancer. However, randomised controlled studies (RCTs) on the effectiveness of such interventions are lacking. We performed a first pilot RCT (n=42) that showed that it is feasible and safe to conduct such a study. Here, we propose a full-scale RCT to investigate the effectiveness and safety of a wilderness programme on the mental and physical health of AYAs affected by cancer. METHODS AND ANALYSIS Participants are 150 AYAs affected by cancer, aged 16-39 years, who will be randomised to a wilderness (n=75) or a hotel stay (n=75). The wilderness programme is an 8-day intervention including a 6-day wilderness expedition. This is followed 3 months later by a 4-day intervention including a 2-day basecamp. Activities include hiking, backpacking, kayaking, rock climbing, mindfulness and bush-crafting. The comparison group is an 8-day hotel stay followed by a 4-day hotel stay (interventions include two travel days) at the same hotel after 3 months. Primary outcomes are psychological well-being and nature connectedness up to 1 year after the study start. Secondary outcomes are quality of life, physical activity and safety parameters. ETHICS AND DISSEMINATION The Swedish Ethical Review Authority approved the study protocol on 27 September 2023 (reference: 2023-05247-01). The recruitment started on 19 February 2024 and the first part is planned to end on 31 December 2027. Study results will be disseminated by means of scientific publications, presentations at conferences, popular articles, interviews, chronicles and books. News items will be spread via social media, websites and newsletters. TRIAL REGISTRATION NUMBER ISRCTN93856392.
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
- Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway Faculty of Health Sciences, Tromso, Norway
| | - Carina Ribe Fernee
- Department of Child and Adolescent Mental Health, Sorlandet Hospital Kristiansand, Kristiansand, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Andreas Stenling
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Psychology, Umeå University, Umea, Sweden
| | - E Anne Lown
- Department of Social & Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - David E Victorson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Ko W, Jeong H. Association between children with attention-deficit hyperactivity disorder and parental mental health: Data from the 2011-2020 Korea National Health and Nutrition Examination Survey. J Affect Disord 2024; 350:544-549. [PMID: 38242216 DOI: 10.1016/j.jad.2024.01.123] [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] [Received: 06/05/2023] [Revised: 10/18/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The aim of this study was to investigate whether children's attention-deficit hyperactivity disorder (ADHD) is associated with parental mental health, using data from the Korean National Health and Nutrition Examination Survey (KNHANES). METHODS This cross-sectional study included 14,428 samples from KNHANES of parents with children younger than 19 years between 2011 and 2020. Mental health problems, measured as perceived stress, depressive symptoms, and suicidality, were assessed. Sociodemographic and health-related characteristics were collected as potential confounding factors. The association between children with ADHD and parental mental health problems was expressed as odds ratio and 95 % confidence interval with multivariate logistic regression using PROC SURVEYLOGISTIC. RESULTS Among the 14,428 participants, 202 (1.4 %) were classified as parents of children with ADHD. Mothers of children with ADHD reported higher perceived stress (aOR = 1.67, 95 % CI 1.09-2.56), depressive symptoms (aOR = 2.93, 95 % CI 1.59-5.40), and suicidality (aOR = 2.63, 95 % CI 1.29-5.38) than those of children without ADHD after adjusting for parents' age, gender, and parental education level, employment status, cohabitation status, drinking, smoking, and number of children. However, fathers' mental health problems were not significantly associated with having a child with ADHD. LIMITATION Because it was conducted the analysis using cross-sectional data, findings on causality are unclear. CONCLUSIONS The current findings suggest that parenting children with ADHD is associated with parental mental health problems. Parents of children with ADHD, especially mothers, need community support and public health attention to help alleviate their mental health problems.
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Affiliation(s)
- Woolim Ko
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Wolfe KR, Martinez A, Dains JE. The Psychosocial Impact of the COVID-19 Pandemic on Adolescent and Young Adult Cancer Survivors in the United States: An Integrative Review. J Adolesc Young Adult Oncol 2024; 13:80-96. [PMID: 37797223 DOI: 10.1089/jayao.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Adolescent and young adult cancer survivors (AYAs) are uniquely challenged with navigating health care systems during an important developmental phase of life. During the Coronavirus disease 2019 (COVID-19) pandemic, many people experienced social isolation, mental health symptoms, and schooling and employment changes, which may have affected vulnerable AYA cancer survivors. The purpose of this integrative review is to explore the psychosocial impact of the COVID-19 pandemic on AYA cancer survivors in the United States. A literature search was conducted in November 2022 using PubMed, Web of Science, and SCOPUS databases with the following search terms: distress*, depress*, lonel*, anx*, insomnia*, cancer*, neoplasm, COVID-19, coronavirus, young adult, AYA, teen*, and adolescen*. The initial search yielded 468 articles. Inclusion criteria required that studies were conducted in the United States, published in English, with a sample of patients diagnosed with cancer between ages 15 and 39. After review and appraisal of each relevant article, eight were included. Through comparative analysis of eight articles, including qualitative and quantitative studies, three themes emerged: mental health impact, health care impact, and financial impact. Mental health impact included increased anxiety, worsening depression and social isolation, and sleep disturbances. Changes in health care included delays in care, medical cost-coping and benefits of virtual care. Financial difficulties included employment changes and benefits of remote work. The COVID-19 pandemic had an immense impact on the psychosocial health of AYA cancer survivors. It is essential that oncology providers and health care teams consider specific interventions to best serve the psychosocial needs of their AYA patients.
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Affiliation(s)
- Kelsey R Wolfe
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashley Martinez
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joyce E Dains
- Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chhajer R, Hira N. Exploring positive psychology intervention and mindfulness-based intervention in nature: impact on well-being of school students in India. Front Public Health 2024; 12:1297610. [PMID: 38356944 PMCID: PMC10864550 DOI: 10.3389/fpubh.2024.1297610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Enhancing the well-being of urban school students is a growing challenge. The online mode of teaching during and post-pandemic era has increased students' daily screen time. As they spend more time indoors, they tend to disconnect from nature even more, adversely impacting their well-being. This study aimed to design and execute two well-being interventions-a positive psychology intervention (PPI) and a mindfulness-based intervention (MBI) in natural settings for urban school students in India. Methods One hundred eighty participants (aged 17-20) from a senior secondary school were randomly assigned to three groups: PPI, MBI, and a control group (CTR). Participants self-reported their levels of well-being, gratitude, inclusion of nature in self, sense of connectedness, resilience, awareness, perceived stress, and positive and negative emotions using a survey questionnaire at two times-pre- and post-interventions. Repeated-measures ANOVA was employed across time and groups, and post hoc analyses for group differences were carried out through the Bonferroni test. Results Results indicate that both PPI and MBI interventions, when executed in natural settings, enhance student well-being, gratitude, inclusion of nature in self, sense of connectedness, resilience, awareness, positive emotions and decreased levels of perceived stress, and negative emotions. Discussion The study provides valuable insights for school authorities, policymakers, and urban planners to include natural settings in school premises and offer well-being interventions for students to connect with nature consciously.
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Affiliation(s)
- Raina Chhajer
- Humanities and Social Sciences Area, Indian Institute of Management, Indore, India
| | - Nainika Hira
- College of Health, Education, and Human Services, Wright State University, Dayton, OH, United States
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Aagesen M, la Cour K, Møller JJK, Stapelfeldt CM, Hauken MA, Pilegaard MS. Rehabilitation interventions for young adult cancer survivors: A scoping review. Clin Rehabil 2023; 37:1347-1374. [PMID: 37083478 DOI: 10.1177/02692155231168720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To map existing research concerning rehabilitation interventions for young adult cancer survivors (YACS) that address at least one factor from the biopsychosocial health model. DESIGN Scoping review. DATA SOURCES Searches were performed in EMBASE, MEDLINE, PsycINFO, CINAHL and Cochrane in January 2022 and updated in March 2023, and grey literature between February and April 2022. METHODS The review followed Joanna Briggs Institute's methodology for scoping reviews. Quantitative, qualitative and mixed methods studies evaluating interventions for YACS of any cancer who had completed primary treatment and were between 18 and 39 years old at diagnosis were included. Two authors independently screened studies for eligibility, and standardised forms were used for data extraction. Descriptive statistics, narrative summaries and thematic analysis were used to analyse the data. RESULTS The search revealed 5706 records, of which 70 were full-text screened. The 20 included studies represented a heterogeneous group of 444 young adults with different cancer types, mean age above 25, and an overrepresentation of females. Most studies were feasibility and pilot studies. The 20 studies consisted of 14 unique interventions focusing primarily on one dimension of the biopsychosocial health model like biological or psychological factors. In the 14 interventions, the most frequent intervention element was peer-to-peer support (n = 12). The interventions were often delivered online (n = 9), lasting 3-12 months (n = 8). A wide variety of theories, providers and outcome measures were used. CONCLUSION The results show that current research on multicomponent, biopsychosocial and age-specific rehabilitation for YACS remains at an early stage.
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Affiliation(s)
- Maria Aagesen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- The Research Unit for User Perspectives and Community-Based Interventions, The Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- The Research Unit for User Perspectives and Community-Based Interventions, The Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christina M Stapelfeldt
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Aarhus N, Denmark
- Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - May Aasebø Hauken
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Marc Sampedro Pilegaard
- Central Region Denmark, DEFACTUM, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Regional Hospital Gødstrup, Herning, Denmark
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Jong MC, Dahlqvist H, Lown EA, Schats W, Beckman L, Jong M. A randomized controlled pilot study assessing feasibility and safety of a wilderness program for childhood, adolescent, and young adult cancer survivors: the WAYA study. BMC Public Health 2023; 23:1504. [PMID: 37553637 PMCID: PMC10410899 DOI: 10.1186/s12889-023-16408-x] [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: 12/08/2022] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The majority of childhood, Adolescent and Young Adult (AYA) cancer survivors suffers from long-lasting health issues following cancer treatment. It is therefore critical to explore effective health promotion strategies to address their needs. Exposure to nature is a promising approach to support the needs of young cancer survivors. This study investigated whether it is feasible to conduct a randomized controlled trial (RCT) of a wilderness program for childhood and AYA cancer survivors. METHODS Eligible participants were aged 16-39 years, had a cancer diagnosis, and met minimal criteria. Seventy-one individuals expressed interest and 59 were randomized to either a wilderness or a holiday program. The wilderness program involved an 8-day expedition including backpacking, sea kayaking, gorge climbing, camping, bush-craft skills, and mindfulness-practices. It was followed by a 4-day basecamp after 3 months. The comparison was an 8-day holiday program at a Spa-hotel followed by a 4-day holiday program at the same hotel after 3 months. Primary outcome was study feasibility and safety. RESULTS Ultimately, 19 AYAs participated in the wilderness and 23 in the holiday program. All completed the study at one-year follow-up. Participants were mostly female (70%) and represented diverse cancers. Clinical characteristics were similar between study arms excepting greater age at cancer diagnosis in the wilderness program (age 19.1 vs. 12.5; p = 0.024). Program adherence and data completeness was high (> 90%) in both arms. Adverse Effects (AEs) in the wilderness vs. the holiday program were similar (Relative Risk: 1.0, 95% Confidence Interval 0.8-1.3). The most frequent AE was tiredness, all were mild to moderate in severity, and serious AEs were not reported. Nature connectedness significantly increased over time in the wilderness program participants, but not in the holiday program (p < 0.001). No differences were found between the two study arms regarding quality of life, self-esteem, or self-efficacy. CONCLUSION It is feasible to conduct a RCT and a supervised wilderness adventure is equally safe for childhood and AYA cancer survivors as a holiday program. This pilot study lays the foundation for a larger RCT to investigate the effectiveness of wilderness programs on the health of young cancer survivors. TRIAL REGISTRATION DATE AND NUMBER 18/02/2021, NCT04761042 (clinicaltrials.gov).
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Affiliation(s)
- Miek C Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden.
- The Arctic University of Norway, National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, UiT, Hansine Hansens Veg 18, 9019, Tromsø, Norway.
| | - Heléne Dahlqvist
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
| | - E Anne Lown
- Department of Social & Behavioral Sciences, University of California San Francisco, 490 Illinois Street, SBS, Box 0612, San Francisco, CA, 94143, USA
| | - Winnie Schats
- Scientific Information Service, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lars Beckman
- Department of Oncology, Sundsvall Hospital, 85186, Sundsvall, Sweden
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
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Timko Olson ER, Olson AA, Driscoll M, Vermeesch AL. Nature-Based Interventions and Exposure among Cancer Survivors: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2376. [PMID: 36767741 PMCID: PMC9916332 DOI: 10.3390/ijerph20032376] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND PURPOSE nature-based interventions (NBI) have been shown to have positive effects on physical, psychological, social, and spiritual health. The purpose of this scoping literature review was to describe what is known regarding the cancer survivor experience in relationship to their interaction with the natural environment. Description/methods: this review was completed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The research strategy included a combination of these terms: cancer, neoplasms, nature, and forest therapy. The articles were blinded and screened by four independent researchers. A total of twelve articles were selected. Outcome/results: a total of 2786 cancer survivors participated in the twelve studies with multiple types and stages of cancer represented. The studies used multiple designs and measures. Results showed improvements in anxiety, depression, sleep, connectedness, stress, tension, confusion, fatigue, and pain. Participants reported that nature was the most important resource in coping with their cancer. CONCLUSIONS AND IMPLICATIONS nature is beneficial for cancer survivors while they experience cancer diagnosis and treatment. Nature opportunities can be feasibly delivered with this population and need to be explored further and safely implemented to support the overall health and well-being of cancer survivors.
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Affiliation(s)
- Erica R. Timko Olson
- School of Nursing, University of Minnesota—Twin Cities, 308 Harvard St. SE, Minneapolis, MN 55455, USA
| | | | - Megan Driscoll
- School of Nursing, University of Minnesota—Twin Cities, 308 Harvard St. SE, Minneapolis, MN 55455, USA
| | - Amber L. Vermeesch
- Department of Family and Community Nursing, School of Nursing, University of North Carolina Greensboro, Greensboro, NC 27403, USA
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Jong MC, Stub T, Mulder E, Jong M. The Development and Acceptability of a Wilderness Programme to Support the Health and Well-Being of Adolescent and Young Adult Cancer Survivors: The WAYA Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12012. [PMID: 36231313 PMCID: PMC9566286 DOI: 10.3390/ijerph191912012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Detailed descriptions of theory, structure, and activities with causal links to specified outcomes of wilderness programs are lacking. Addressing this gap, the present qualitative study gives a thorough description of the development of the Wilderness programme for Adolescent and Young Adult (AYA) cancer survivors (WAYA). WAYA is adapted to the individual needs of AYA cancer survivors. It was conceived around Næss's ecosophy and the Positive Health Model, and refined based on findings from a scoping review and patient/public involvement. Programme aims were to increase physical activity, self-confidence, personal growth, joy, safety within nature, meaningful relationships, and self-efficacy. The programme was an eight-day expedition followed three months later by a four-day base-camp. Activities included hiking, backpacking, kayaking, rock climbing, mindfulness and bushcrafting. Evaluation of the programme through focus group and individual interviews with 15 facilitators and 17 participants demonstrated that a diverse group of participants, challenging activities, and mindfulness-based practices were found to positively influence group bonding and the learning process. Furthermore, including an expedition and base-camp component was found to be beneficial in supporting the development of participants' own personal outdoor practices. In conclusion, this study demonstrated that the WAYA programme is safe and well accepted by AYA cancer survivors.
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Affiliation(s)
- Miek C. Jong
- National Research Centre in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, UiT, Hansine Hansens veg 18, 9019 Tromsø, Norway
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
| | - Trine Stub
- National Research Centre in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, UiT, Hansine Hansens veg 18, 9019 Tromsø, Norway
| | - Eric Mulder
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
| | - Mats Jong
- Department of Health Sciences, Mid Sweden University, Holmgatan 10, 851 70 Sundsvall, Sweden
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Cancer Survivors’ Disability Experiences and Identities: A Qualitative Exploration to Advance the Cancer Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053112. [PMID: 35270802 PMCID: PMC8910238 DOI: 10.3390/ijerph19053112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/10/2022]
Abstract
Eliminating cancer-related disparities is a global public health priority. Approximately 40% of cancer survivors experience long-term effects of cancer which can lead to activity limitations and participation restrictions; yet discussions of disability are largely absent from clinical and research cancer health equity agendas. The purpose of this study was to explore how cancer survivors experience and make sense of the long-term disabling effects of cancer and its treatments. In this qualitative study, data were collected via in-depth semi-structured interviews with survivors of breast cancer, head and neck cancer, and sarcoma (n = 30). Data were analyzed thematically using a 2-phase iterative process proceeding from descriptive to conceptual coding. Survivors experienced a wide range of long-term physical, sensory, cognitive, and emotional effects, that intertwined to restrict their participation in self-care, work, leisure, and social roles. While the interaction between impairments and participation restrictions meets the definition of disability; participants articulated a range of responses when asked about their disability identity, including (1) rejecting, (2) othering, (3) acknowledging, and (4) affirming. Findings may be indicative of structural and internalized ableism which can impede cancer care and survivorship. To support cancer survivors’ transition to post-treatment life, cancer care providers should implement anti-ableist practices and engage in frank discussions about cancer’s long-term impacts.
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