“Christmas Balls”: A Christmas Carol by the Adolescent Cancer Patients of the Milan Youth Project

I was only sixteen

This short piece describes a new project developed by the adolescent patients with cancer involved in the Youth Project at the Istituto Nazionale dei Tumori in Milan, Italy. This is a scheme dedicated to young cancer patients with the dual aim of optimizing medical aspects of their care and promoting a holistic approach to their needs. "I was only sixteen" is a ballad, written in English by the patients, that became a song with the help of professional musicians (and among them international star Tony Hadley, former frontman of Spandau Ballet). This song sounds like hymn to life for teenagers with cancer in the world. It emphasizes again the value of giving young patients novel creative ways to express themselves.

The power of art and the powers of adolescents with cancer: Age-specific projects at Italian pediatric oncology centers

This article describes the oncology programs developed in Italy for adolescents and young adults with cancer, with a specific focus on the local projects created in pediatric oncology centers. A common feature of such projects is the emphasis on creative and artistic activities and laboratories (involving music, photography, novel writing, fashion design, and so on) designed to give young patients innovative means of expression.This article highlights the amazing powers of adolescents involved in these projects: the power to produce beautiful things in a place that is not normally associated with the idea of beauty; the power to make their doctors smile and grasp the profound sense of life; the power to make hospitals become places for producing culture.

Playing cards designed by young cancer patients with the Youth Project in Milan

This short piece briefly describes a creative project undertaken by a group of adolescent and young adult cancer patients as part of our Youth Project (a scheme dedicated to young cancer patients with the dual aim of optimizing medical aspects of their care and promoting a holistic approach to their needs, including the organization of artistic activities). In this project, young cancer patients designed their personalized playing cards, with kings receiving chemo, queens wearing bandanas, jacks dressed as nurses, and jokers as doctors. The playing cards, with the patients' own words, contain a little bit of these young cancer patients' stories in them.

"Based on a true story" podcast: a journey into the world of young patients with cancer

This article describes a creative project undertaken by a group of adolescent and young adult patients with cancer as part of the Milan's Youth Project, a scheme dedicated to young patients with cancer with the dual aim of optimizing medical aspects of their care and promoting a holistic approach to their needs. The project was based on audio recordings and focused on the theme of "the journey," such as a holiday or an adventure, or as a metaphor of the cancer experience. The podcast installments were published on the main streaming platforms. Talking about their disease and how they feel is of importance for young patients to process their feelings surrounding the cancer experience and to find the inner resources they need to facilitate coping.

My mind is still mine: a self-portrait in a photography project for adolescents and young adults with cancer

This commentary describes the unusual self-portrait contributed by a 26-year-old receiving treatment for relapsing medulloblastoma to a photography project undertaken by a group of patients as part of the Youth Project, a scheme dedicated to young cancer patients with the dual aim of optimizing medical aspects of their care and promoting a holistic approach to their needs. The article briefly describes how creative projects can play an important part in giving young people with cancer new ways to tell their stories and express their feelings. There is still a limited understanding of the specific needs of adolescents and young adults with cancer, and it is important to draw attention to them and to the need to devise a person-centered approach to cancer patients in this age group.

Adolescents with cancer on privacy: Fact-finding survey on the need for confidentiality and space

BACKGROUND

Cancer diagnosis and related treatment can limit young patients' privacy. Their need for private physical and psychological spaces can be impeded by limited freedom, e.g., sharing hospital rooms with others and exposing their body to their parents and doctors.

METHODS

We conducted a survey among young patients of our center to investigate how their perception of privacy changed after being diagnosed with cancer and their need for hospital dedicated physical spaces and time for patients to enjoy their privacy. A questionnaire with 16 items was developed by the staff involving psychologists and physicians. The relevance of changes before and after the cancer diagnosis was assessed by calculating two scores indicating the situation before and after diagnosis for each answer, as well as a delta score.

RESULTS

Between May and June 2020, the questionnaire was completed by 60 patients aged 16-24 years. The median delta scores describing the changes before and after diagnosis were -8 points for perception of privacy, indicating a significant decrement of the level of privacy perceived. A major issue was the constant presence of parents being perceived as intrusive. Concerning hospital dedicated physical spaces and time for patients to enjoy their privacy, respondents requested dedicated spaces (50% of patients) and opportunities to have private interviews with medical personnel (88%).

CONCLUSIONS

Our study offers a snapshot of how young people with cancer perceive the impact of the disease and its treatment on their privacy with the restrictions imposed on their individual freedom. Patients' personal needs must be taken into consideration to adopt appropriate measures and better organize wards.

Experiencing Social Isolation (Even in the Era of COVID-19 Pandemic Lockdown): Teachings Through Arts from Adolescents with Cancer

The article describes how adolescents with cancer utilized an artistic approach to discuss about their social isolation caused by disease and treatment. With the help of professionals, 17 young patients closed in their isolation room described their ideal room (a bit real, a bit of a fantasy place) producing texts and images, subsequently put together into a book. In these days when people are forced to social isolation by the lockdown related to corovavirus disease 2019 pandemic, young patients teach us meaningful life lessons: how social confinement can become an opportunity to focus on yourself, and what is really important in life.

How young patients with cancer perceive the COVID-19 (coronavirus) epidemic in Milan, Italy: Is there room for other fears?

The rapid spread of coronavirus disease 2019 epidemic in Italy, in particular in the Milan focal point, required drastic measures and led to panic in the population. While in our center we did not change our approach to the treatment of our young patients with cancer, we developed a qualitative survey to assess their perception of the risk and level of stress. The survey showed that a relatively large proportion of young patients felt personally at risk of severe complications. We believe that we need to adequately inform our patients, focusing on hygienic measures and personal protection and prompt reporting of any suspicious symptoms.

Loop: there's no going back: A Graphic Novel by Adolescent Cancer Patients on the Youth Project in Milan

The present paper describes the story of the development of a graphic novel-a story about superheroes-written by adolescent cancer patients on the Youth Project at the Istituto Nazionale Tumori in Milan (Italy). Nineteen patients from fifteen to twenty-five years old (fifteen receiving treatment for their cancer, four who had recently completed their treatments) participated in a four month creative writing laboratory managed by a professional teacher. The output from the writing laboratory was a written text that was used as the script for a graphic novel drawn by professional cartoonists and working together with the patients. Through their story, adolescent patients succeeded in voicing their dreams and fears. It was the adolescent patients themselves who explained how they had each tried to bring out the superhero inside them. This project describes the amazing powers of adolescents with cancer and opens a precious window on their inner world, enabling us to gain a better understanding of what they are really thinking and feeling through their own words.

Models of Care-There Is More Than One Way to Deliver

Adolescents and young adults (AYAs) with cancer constitute a particular group of patients with unique features, whose needs during and after treatment are poorly met. A standardized model of care for them has yet to be established, as neither the pediatric nor the adult oncology systems seamlessly fit their needs. Regardless of the setting in which they are treated, their health care providers should be aware of the impact that the disease and its treatments have on these especially vulnerable patients. Simple ways of improving the AYA experience should be considered: reducing isolation through connections with peers, adapting the staff's approach to the emotional and developmental needs of this age group, and modifying the hospital environment making it more age appropriate. Commitment of national governments is valuable; building and sharing international experience will accelerate advances in clinical care, education, and research. Further progress in the care of AYA cancer patients is still needed to improve their outcomes.

"Summer is you": Adolescents and young adults with cancer sing about their desire for summer

Creative spirit and art are used as part of the Youth Project in Milan, a program dedicated to adolescents and young adults (AYA) with cancer. The "Summer is you" music project involved 45 patients (15-26 years old): with professional help, the patients wrote music and lyrics, sang their song, and recorded a video clip, sharing with us not only their hopes and fears, but also their romantic encounters and their urge to travel (https://youtu.be/Q5FSCMUVg0E). This project exploited the power of music to bring young people with cancer together in a novel form of support that can complement the more conventional psychological approaches.

Diary of a journey to a faraway galaxy

This article describes a brief account written by a girl treated with chemotherapy and surgery for an ovarian germ cell tumor. The brief novel was conceived in the context of the Youth Project of Milan, dedicated to helping adolescent and young adult cancer patients socialize and express themselves through group activities that focus on art and creativity. It describes the scenery of a new galaxy and is replete with images and metaphors that recall the experience of receiving anticancer treatment, touching on emotional themes including desire, isolation, fear, and hope.

The concept of friendship in adolescents with cancer: Reflections and experiences

Cancer can erupt in an adolescent's life, damaging his or her multidimensional balance with its burden of physical suffering, changes in appearance, and anxiety, interrupting their activities, keeping them away from school, and isolating them socially. It is crucially important for adolescents with cancer to be able to feel the same as before, to feel they belong to a group of schoolmates. This is not always easy to achieve. Their peers sometimes lack the necessary resources to treat adolescents with cancer as normal ones, responding instead with pity or avoidance. This article discusses the concept of friendship in adolescents with cancer, based on direct experience of being with them, personal reflections, and texts chosen and shared with the patients, as part of the cultural activities dedicated to adolescents and young adults with cancer at the Youth Area of the Centro di Riferimento Oncologico, Aviano, and the Youth Project at the Istituto Nazionale Tumori, Milan, Italy.

"What shall I do when I grow up?" Adolescents with cancer on the Youth Project in Milan play with their imagination and photography

INTRODUCTION

Adolescents diagnosed with cancer have to temporarily stop pursuing several vital needs and making plans for the future. The Youth Project in Milan, Italy, focuses on such issues in young cancer patients' personal lives. Uncertainty about the future had already emerged in several artistic projects designed to help these patients voice their emotions.

METHODS

We describe a project revolving around the question "What shall I do when I grow up?" Twenty-seven 15- to 26-year-old patients wrote a brief account of what they hoped to do as adults. Using theatrical costumes, they then dressed up in their chosen role for a photo shoot with a well-known professional photographer. The results were published in one of Italy's main national dailies.

RESULTS

Participants reacted differently: some lightheartedly, others more seriously. They often expressed the wish to help others, desiring to return the support and protection they had received as patients. Another common theme concerned their need for normality.

CONCLUSIONS

By writing about their dreams, these patients gave their doctors a glimpse of their inner world. The project proved an important complement to more conventional forms of psychosocial support and interaction with young patients.

Dreams and illusions in adolescents with terminal cancer

Being diagnosed with cancer in adolescence generally has important emotional consequences: adolescent cancer patients need to be seen as special cases with particular medical and psychosocial needs. This is especially true when a young patient is faced with a progressive, incurable disease. Herein, we report the story of a 17-year-old girl with a metastatic refractory soft tissue sarcoma who tells her dream to the psychologist of the ward. Telling this narrative is the opportunity to discuss the complex topic of how adolescent cancer patients adapt to the terminal stage of their disease; for example, the patient needs to talk to someone about their fear of dying; the healthcare operators need to be able properly listen and communicate; the patient's trust in the future despite their clinical condition; the necessity to leave space for hope; the useful role of the imagination sphere; the issue of whether and how to tell a person who is terminally ill the truth about their condition.

Cooperation between in-hospital psychological support and pastoral care providers: obstacles and opportunities for a modern approach

The meaning that patients with cancer attribute to life influences their expectations and their attitudes to the disease and its treatment. Over the centuries, religion has commonly been the answer encoded by the social setting when it came to matters of life and death. The present article analyzes the historical grounds for forms of cooperation between the scientific disciplines that focus on mental health and the approach of religion, centered on the Italian situation. Such cooperation was hard to imagine in the past, but the situation has changed considerably and cooperation is not only possible but extremely desirable. Acknowledgment of their spiritual needs helps patients to battle with their disease. The care of patients should include catering for their spiritual needs by ensuring the constant presence of a chaplain on hospital wards.

A reflection on the work of Gianni Bonadonna from the viewpoint of the global challenge of adolescents and young adults with cancer

Adolescents and young adults (AYAs - ages 15 to 39) constitute approximately 40% of the world's population and contribute an estimated one million new cases of cancer annually, the great majority in low- and middle-income countries (LMICs). In high-income countries (HICs) cancer is the commonest cause of disease-related death in AYAs, though overall 5-year survival rates now exceed 80%. A very different circumstance likely holds in LMICs, but accurate assessments are not readily available.Breast cancer accounts for 40% of tumours in female AYAs and this age group includes the peak incidence of Hodgkin lymphoma. The late Professor Gianni Bonadonna contributed importantly to improved survival in patients with these two diseases. Accordingly, he would be justifiably proud of the advances in AYA oncology that are being made in Italy, especially the impact of his colleagues at the Istituto Nazionale dei Tumori (INT). The initiatives of the Associazione Italiana Ematologia Pediatrica and the Società Italiana Adolescenti con Malattie Onco-ematologiche are particularly noteworthy, with the accomplishment of productive collaboration between paediatric and adult cancer care providers serving as a model for other countries to emulate.Exporting these advances can be successful through the vehicle of "twinning": establishing sustainable cooperation between institutions in HICs and partners in LMICs. Colleagues in Monza and at INT have been leaders in such programmes for decades. Cancer in AYAs remains a global challenge to which Gianni Bonadonna surely would have risen with enthusiasm and leadership while securing measurable achievements.

Winners' Cup: A National Football Tournament Brings Together Adolescent Patients with Cancer from all over Italy

Società Scientifiche Italiane Insieme per gli Adolescenti con Malattie Onco-ematologiche (SIAMO) is an Italian nationwide scheme that focuses on adolescent patients with cancer. Some of its activities include promoting dedicated local projects at the various oncology centers all over the country and organizing events to improve awareness regarding cancer in adolescence. It is with these aims in mind that it organized the Winners' Cup, a football tournament between Italian adolescents who had (or had had) pediatric cancers. There were 144 young people 15 to 24 years old who arrived from 16 different treatment centers around the country to take part in the tournament and share their stories. Such an event had never been attempted before, in Italy at least. The Winners' Cup was a great success and an opportunity to focus attention on the particular clinical, psychological, and social needs of cancer patients in this age group.