Feasibility pilot trial of a tailored medication adherence-promotion intervention for adolescents and young adults with cancer: Study design and protocol

BACKGROUND

Medication non-adherence is common among adolescents and young adults (AYAs) with cancer and associated with poor health outcomes. AYAs with cancer endorse multiple barriers to adherence that differ across individuals, suggesting that tailoring intervention content to an AYA's specific barriers may have the potential to improve adherence. The purpose of this manuscript is to report on ORBIT-guided Phase I design efforts to create the first tailored adherence-promotion intervention for AYAs with cancer and the study protocol for the ongoing Phase II pilot feasibility trial.

METHODS

Phase I design included qualitative interviews (n = 15 AYAs) to understand patient preferences for adherence-promotion care, development and refinement of a best-worst scaling exercise barriers tool (n = 5 AYAs), and development of intervention modules and a tailoring algorithm. In the ongoing Phase II pilot feasibility trial, AYAs (ages 15-24 years) with cancer currently taking oral chemotherapy or prophylactic medication will be recruited from three children's hospitals. Feasibility, acceptability, and usability will be assessed and these outcomes along with data on medication adherence will be used to inform the next phases of intervention development and testing.

CONCLUSIONS

If promising, this program of research ultimately has the potential to equip clinicians with additional strategies for supporting adherence among AYAs with cancer. NCT05706610.

Social determinants of health predict health outcomes following pediatric allogeneic hematopoietic stem cell transplant

BACKGROUND

Pediatric hematopoietic stem cell transplantation (HCT) is an intensive medical procedure that places substantial financial and logistical burdens on families and is associated with significant health risks, such as graft-versus-host disease (GVHD), and infections. The influence of the social determinants of health (SDoH) on outcomes following pediatric HCT is understudied. This study aimed to examine whether SDoH predicts outcomes following pediatric HCT.

PROCEDURE

Data were collected from 84 children who received HCT (Mage  = 5.8 years, SD = 3.7) and their primary caregiver. Detailed demographic information was collected from caregivers at baseline, and child health information was extracted from the electronic medical records. Multivariate logistic regression was used to examine the association between SDoH and health outcomes within a 24-month period following pediatric HCT.

RESULTS

After controlling for malignancy as reason for transplant and donor type, lower family income predicted the incidence of chronic GVHD. Neighborhood deprivation, total family income, public health insurance, caregiver relationship status, caregiver educational attainment, and perceived family financial difficulties did not predict acute GVHD or the number of infections.

CONCLUSIONS

Total family income is a simple family indicator of SDoH that predicts chronic GVHD after pediatric allogeneic HCT. These findings provide further support for the importance of screening of child and family SDoH risks to ensure that fundamental needs can be met to mitigate potential health disparities for up to 2 years following pediatric HCT.

Sleep health behaviors in pediatric patients with newly diagnosed cancer

OBJECTIVE

Disrupted sleep and fatigue are common symptoms in children with cancer, but little is known about this population's sleep health behaviors and how they may impact nighttime sleep. We aimed to describe the sleep health behaviors of children with newly diagnosed cancer and to determine if they changed over the next 8 weeks.

METHODS

Our sample included 169 children with cancer (86 males) who were aged 2-18 years (mean [SD] = 8.14 [4.4] y), with parent proxy report for 140 children (71 male) aged 2-12 years (mean [SD] = 6.67 [3.2] y) and self-report for 78 children (39 male) aged 8-18 years (mean [SD] = 12.0 [2.9] y). Parents and patients completed sleep hygiene questionnaires within 30 days of oncology diagnosis (T1); follow-up questionnaires were collected 8 weeks later (T2). Descriptive analyses characterized the sample by sociodemographic characteristics, cancer diagnosis, treatments received, and prescribed medications.

RESULTS

Age-related differences were found in sleep health behaviors, with adolescents reporting better overall sleep health behaviors than younger children at both time points. No differences in sleep health behaviors were found at T1 related to diagnosis, treatment, or medications. Some differences in sleep health behaviors were found at T2 related to gender, diagnosis, treatment, and medications. Sleep health behaviors and sleep problems remained relatively stable over 8 weeks. Fatigue was significantly associated with more pre-bedtime worries, insomnia, and lower rates of daytime sleepiness.

CONCLUSIONS

These findings offer novel descriptive characteristics of sleep health behaviors in a pediatric oncology sample and show relatively stable yet somewhat poor sleep health behaviors across 8 weeks. Better understanding of sleep health behaviors as modifiable factors will help inform targeted interventions.

Systematic Evaluation of the Behavior Change Techniques and Quality of Commercially Available Cancer Self-Management Apps

PURPOSE

Apps have the potential to aid in cancer self-management, but there is limited guidance available for selecting among currently available options. The purpose of this study is to evaluate the behavior change techniques (BCTs) and quality of publicly available cancer self-management apps.

METHODS

Cancer self-management apps were identified from the Apple and Google Play stores in April 2022. Trained study team members coded the BCTs included in each app and rated its quality using the Mobile App Rating Scale (MARS). BCTs supported by previous literature were coded as cancer management BCTs.

RESULTS

The 39 apps meeting inclusion criteria included an average of 5.85 BCTs (standard deviation [SD], 3.49; range, 0-15) and 3.54 cancer management BCTs (SD, 1.90; range, 0-8). The most commonly included BCTs were educational or informational strategies: provide information about behavior-health link, provide instruction, and provide information on consequences. The overall app quality ranged from 1.69 to 4.20 (M, 3.29; SD, 0.67).

CONCLUSION

No cancer self-management apps were of excellent quality, and less than half included multiple cancer management BCTs beyond education. Clinical implications are discussed, and opportunities to improve the content and quality of apps to address the critical self-management needs of patients diagnosed with cancer are highlighted.

"I Did It to Save My Children": Parenting Strengths and Fears of Women Exposed to Intimate Partner Violence

Intimate partner violence (IPV) is experienced by one in four women in the United States, and a wealth of quantitative research has underscored its detrimental effects on women's mental health and parenting practices. Little research, however, has considered ways in which women exposed to IPV retain and foster parenting strengths and ways in which motherhood serves as a source of resilience for these women. The objective of the current study was to conduct a thematic analysis of IPV-exposed women's parenting strengths and concerns as reported through focus groups conducted with IPV-exposed women (n = 22) and service providers (n = 31) in two urban areas in the Mid-West and Mid-South. Results of the thematic analysis indicated the emergence of three core themes: resilience and challenges of parenting in the context of IPV, leaving the violent partner, and intergenerational processes. Overall, service providers recognized far fewer strengths in parenting on all dimensions than did women, suggesting that service providers may be conceptualizing parenting in the context of IPV from a deficit model that underestimates the resilience demonstrated by these women. This has important consequences for the extent to which women may feel stigmatized or blamed when receiving resources and services critical to their families. Future research on parenting among women experiencing IPV would be enhanced by capturing the dynamic interplay between women's parenting strengths and challenges, and the ways in which these capacities are affected by resource access within and across social ecological contexts.

Differentiating the effects of anxious and avoidant attachment on depression and resilience following trauma

Objective Few studies have explored the impact of insecure attachment on college student mental health. The present study examined how anxious and avoidant attachment to a mother, father, and best friend were related to depression and resilience in emerging adults exposed to trauma. Participants: Participants included 372 trauma-exposed emerging adults, aged 18-24 (M_age=19.64, SD = 1.62), from a university in the Midsouth, United States. Method: Participants completed an assessment battery of self-report measures to determine how maternal, paternal, and best friend insecure attachment each uniquely contribute to the variance in depression and resilience. Results: Hierarchical linear regression analyses revealed that anxious and avoidant attachment to a best friend were associated with lower resilience, but only anxious attachment to a best friend was associated with more depressive symptoms. Discussion: Findings highlight the importance of cultivating healthy relationships in a university setting to foster secure peer attachments for emerging adults exposed to adversity.

Associations between Substance Use and Depressive Symptoms among Women Experiencing Intimate Partner Violence

Associations between substance use and depression among women experiencing intimate partner violence (IPV) have received limited empirical attention. This study examined how demographics, frequency of IPV and problematic substance use were related to depressive symptoms among women exposed to recent IPV. Participants included 112 women (M_age = 32.26; 67% Black) recruited from community organizations in the U.S. Midsouth, many of whom had used substances (80.2%) and were living below the poverty threshold (71.3%). Results from a hierarchical multiple regression analysis revealed that, after accounting for age and income, more frequent IPV and more problematic tobacco use were associated with higher depressive symptoms. Neither alcohol nor illicit substance use were significantly associated with depressive symptoms. These findings highlight a meaningful connection between problematic tobacco use and depressive symptoms, indicating the potential benefits of incorporating tobacco use psychoeducation and cessation strategies into treatment programs for women experiencing depression in the context of IPV.

Feasibility and Acceptability of Light Therapy to Reduce Fatigue in Adolescents and Young Adults Receiving Cancer-Directed Therapy

OBJECTIVE/BACKGROUND

Fatigue is one of the most consistent and distressing symptoms reported by adolescent/young adult (AYA) oncology patients. Bright white light (BWL) is used to treat fatigue in adult oncology but has not been explored in AYA oncology patients. The purpose of the current study was to determine the feasibility and acceptability of BWL for AYA who were receiving cancer-directed therapy.

PARTICIPANTS

51 AYA patients with newly diagnosed solid tumors, including lymphoma.

METHODS

Participants were randomized to dim red light (DRL, n = 25) or BWL (n = 26) from devices retrofitted with adherence monitors for 30 minutes upon awakening daily for 8 weeks. Side effects were assessed via modified Systematic Assessment for Treatment-Emergent Effects (SAFTEE). Participants completed the PedsQL Multidimensional Fatigue Scale.

RESULTS

Of patients approached, 73% consented and participated. Mean adherence was 57% of days on study with 30.68 average daily minutes of usage. BWL did not cause more extreme treatment-emergent effects over DRL. Patients in the BWL group demonstrated significant improvement on all fatigue outcomes by both self-report and parent proxy report, which was not observed in the DRL group.

CONCLUSIONS

This is the first study to evaluate the feasibility and acceptability of light therapy to reduce fatigue in AYA patients receiving cancer-directed therapy. These findings demonstrate the feasibility and acceptability of the intervention and provide preliminary evidence of the potential benefits of BWL, which warrants further study in a confirmatory efficacy trial.ClinicalTrials.gov Identifier Number: NCT02429063.

Mother-child communication about possible cancer recurrence during childhood cancer survivorship

OBJECTIVE

Providing opportunities to communicate about possible cancer recurrence may be adaptive for youth in remission, yet parents may experience difficulty guiding discussions related to fears of cancer recurrence (FCR). This study aimed to characterize mother-child discussions about potential cancer recurrence during post-treatment survivorship and to determine predictors of maternal communication.

METHODS

Families (N = 67) were recruited after the child's initial cancer diagnosis (age 5-17 years) and mothers self-reported their distress (post-traumatic stress symptoms; PTSS). During survivorship 3-5 years later, mothers were video-recorded discussing cancer with their children. Presence and length of discussion about potential cancer recurrence, triggers for FCR, expressed affect, and conversational reciprocity were examined. Hierarchical regressions were used to assess maternal PTSS near the time of cancer diagnosis and child age as predictors of maternal communication.

RESULTS

Three-quarters of dyads spontaneously discussed risk for or fears about cancer recurrence; mothers initiated the topic more frequently than their children. Dyads discussed internal (bodily symptoms) and external (medical, social) triggers of FCR. Higher maternal PTSS at diagnosis predicted significantly lower levels of maternal positive affect (β = -0.36, p = 0.02) and higher levels of maternal negative affect (β = 0.30, p = 0.04) during discussion of recurrence 3-5 years later. Older child age significantly predicted higher levels of maternal negative affect (β = 0.35, p = 0.02). Higher maternal PTSS at diagnosis predicted shorter discussions about recurrence for younger children (β = 0.27, p = 0.02).

CONCLUSIONS

Understanding predictors and characteristics of mother-child discussions about recurrence can guide family-based FCR interventions, particularly those promoting communication as a supportive tool. Both maternal PTSS and child age are important to consider when developing these interventions.

A latent profile analysis of coping responses to individuals' most traumatic event: associations with adaptive and maladaptive mental health outcomes

Background & Objectives: This study explores how empirically-derived coping response patterns influence mental health. Design: Emerging adults, currently enrolled in college and aged 18-24 (N = 432; M_age= 19.66; SD = 1.65), completed self-report measures of trauma exposure, coping responses to self-selected most traumatic event (MTE), resilience, posttraumatic growth (PTG), depressive symptoms, and posttraumatic stress symptoms (PTSS). Methods: Eight coping subscales were included as indicators in a latent profile analysis. Then, associations between established profiles and mental health outcomes were examined, covarying for demographic and trauma-related variables. Results: Considering fit statistics, class size, profile patterns, and theory, the four-class model was deemed most appropriate: High Overall Coping (HCOPE; n = 146, 34%), Low Overall Coping (LCOPE; n = 92, 22%), High Engagement Coping (HENG; n = 115, 27%), and High Disengagement Coping (HDIS; n = 73, 17%). HENG participants endorsed above-average resilience and PTG, coupled with below-average depressive symptoms and PTSS. Compared to the sample average, HDIS participants endorsed lower resilience and PTG, coupled with higher depressive symptoms and PTSS. LCOPE participants endorsed low levels of all outcomes. HCOPE participants endorsed high levels of all outcomes. Conclusions: Findings suggest that clinicians who promote engagement coping and discourage disengagement coping among trauma-exposed individuals may engender the most desirable constellation of mental health outcomes.

A concurrent examination of protective factors associated with resilience and posttraumatic growth following childhood victimization

The present study concurrently examined protective factors associated with the adaptive outcomes of resilience and posttraumatic growth (PTG; defined as positive psychological change resulting from a life crisis or trauma), after accounting for relevant demographic factors and the impact of circumstances surrounding childhood victimization (i.e., age of first trauma, frequency of victimization, and perception of trauma severity). The protective factors examined in the present study included social support from friends and family, optimism, positive religious coping (i.e., looking to God for support and guidance; forgiveness), and negative religious coping (i.e., feeling abandoned by God; anger towards God). Participants included 161 college students from the US MidSouth, aged 18-24 (M_age = 19.97, SD = 1.86). All participants reported experiencing physical violence and/or sexual abuse during their childhood. Hierarchical multiple regression analyses indicated that after accounting for demographics and circumstances surrounding the childhood victimization, higher resilience was associated with greater family support, optimism, and positive religious coping, while higher posttraumatic growth was associated with greater optimism and positive religious coping. These findings underscore the protective role of optimism with respect to both resilience and posttraumatic growth. Additionally, results highlight the importance of examining cognitions related to religious coping rather than simply assessing broadband religiosity, as only positive religious coping was associated with adaptive outcomes. Findings suggest the importance of early intervention to bolster protective factors (i.e., family support, positive thinking, gratitude, and positive religious coping skills) among youth exposed to childhood physical and sexual victimization.

Effect of time since loss on grief, resilience, and depression among bereaved emerging adults

Grief research has typically centered on one time point, without considering the impact of multiple losses over time. In this study, 546 bereaved emerging adults were divided into three groups: those who experienced a recent loss (0-2 years ago), a past loss (>2 years ago), or a combination of both recent and past losses. Differences between the groups on resilience, depression, and grief symptomatology were examined. Those who had experienced both losses (recent and past) and recent losses endorsed significantly more grief symptoms than those in the past loss group. Findings highlight how multiple losses impact grief.

Protective Factors associated with Resilience in Women Exposed to Intimate Partner Violence

OBJECTIVE

Research on adversity is often skewed toward assessing problematic functioning; yet many women display resilience following traumatic experiences. Examining individual, relational, community, and cultural variables can provide new knowledge about protective factors associated with resilience in women exposed to intimate partner violence (IPV). Controlling for demographics and circumstances of the violence, this study evaluated predictors of resilience, including spirituality, social support, community cohesion, and ethnic identity.

METHOD

The sample consisted of 112 women (M_age =32.12, SD=5.78) exposed to physical, psychological, and/or sexual intimate partner violence in the past 6 months. Approximately 70% of participants were Black. Hierarchical linear regression modeling was conducted to examine factors related to resilience. Model 1 included demographics (age, education, and socioeconomic status) and stressful life experiences. Model 2 added circumstances of the violence: IPV severity, IPV perpetration by participant, and number of violent partners. The third and final model added spirituality, social support, community cohesion, and ethnic identity.

RESULTS

The final model was significant, F(11, 97)=6.63; p<.001, adj. R² =36.5%; with greater social support (β=.24; p=.009), more spirituality (β=.28; p=.002), and fewer violent relationships (β= -.25; p=.003) predicting higher resilience among women exposed to IPV.

CONCLUSION

While risk factors associated with IPV are well-researched, little is known about factors related to resilient functioning, especially among minority populations. Knowledge gained from this study can advance the field of violence research by its identification of potentially mutable variables related to resilience. Such research could be applied to developing strength-based interventions for at-risk populations of violence-exposed women.

The moderating role of trauma type on the relationship between event centrality of the traumatic experience and mental health outcomes

OBJECTIVE

Event centrality, or the extent to which traumatic events are perceived to be integral to one's life, has been found to be predictive of trauma-related symptoms, such as posttraumatic stress disorder (PTSD) and depression. Less research has been devoted to whether event centrality is related to adaptive outcomes, such as posttraumatic growth (PTG) and resiliency, and psychological well-being (PWB) has not been investigated. Given the unique circumstances of different types of traumas, the relationship between event centrality and posttrauma functioning may differ by the type of trauma experienced.

METHOD

The present study investigated the direct relationships between event centrality and PTSD, depression, PTG, resiliency, and PWB, and then examined whether type of trauma (i.e., sexual victimization, death of a loved one, serious illness/injury, violence exposure) moderated the relationship between event centrality and mental health outcomes among 429 trauma-exposed college students (M_age = 19.66, SD = 1.65; 78.6% female; 49.9% White).

RESULTS

Event centrality was positively related to PTSD, depression, and PTG, inversely linked with multiple indices of PWB, and unrelated to resiliency. Type of traumatic event moderated the relationship between event centrality and PTSD, as well as 4 subscales of PWB. When sexual trauma was the index event, event centrality was more strongly associated with PTSD and aspects of PWB compared to death of a loved one.

CONCLUSIONS

Findings indicate the importance of trauma type when disentangling the relationships between event centrality and negative and positive outcomes and demonstrate the relevance of event centrality in understanding posttrauma functioning. (PsycINFO Database Record

The relationship between types of childhood victimisation and young adulthood criminality

BACKGROUND

Previous research suggests that some types of childhood abuse and neglect are related to an increased likelihood of perpetrating criminal behaviour in adulthood. Little research, however, has examined associations between multiple different types of childhood victimisation and adult criminal behaviour.

AIMS

We sought to examine the contribution of multiple and diverse childhood victimisations on adult criminal behaviour. Our central hypothesis was that, after controlling for gender, substance use and psychopathy, each type of childhood victimisation - specifically experience of property offences, physical violence, verbal abuse, sexual abuse, neglect and witnessed violence - would be positively and independently related to criminal behaviour in young adults.

METHODS

We examined data from a large, nationally representative sample of 2244 young Swedish adults who reported at least one form of victimisation, using hierarchical regression analysis to also account for gender, substance use and psychopathy.

RESULTS

Experiences of physical assaults, neglect and witnessing violence as a child were significantly associated with adult criminal behaviour, but not experiences of property, verbal or sexual victimizations.

CONCLUSIONS

Our findings help to identify those forms of harm to children that are most likely to be associated with later criminality. Even after accounting for gender, substance misuse and psychopathology, childhood experience of violence - directly or as a witness - carries risk for adulthood criminal behaviour, so such children need targeted support and treatment. Copyright © 2016 John Wiley & Sons, Ltd.

The "less than optimal" cytology: importance in obstetric patients and in a routine gynecologic population

OBJECTIVE

To determine whether patients with less than optimal Papanicolaou tests constitute a low-risk group for developing subsequent abnormalities and thus do not need early repeat screening.

METHODS

For the 10-month period October 1989 to August 1990, all screening Papanicolaou tests were classified by the 1988 Bethesda System. Tests designated as less than optimal solely on the basis of lack of an endocervical component were the subject of the study. Prenatal patients with less than optimal tests had repeat tests at the postpartum visit (delayed-repeat group), whereas gynecologic less than optimal tests were repeated within 4 weeks (early-repeat group). The frequency of cytologic abnormalities in our routine gynecologic population was compared with that for both the delayed- and early-repeat testing groups.

RESULTS

The less than optimal rate in obstetric patients was 10.2% (153 of 1492), which was significantly higher than the 5.6% rate (473 of 8411) in the routine gynecologic population (P < .0001). The rates of dysplasia or combined abnormalities (dysplasia, human papillomavirus, or atypia) in the delayed-repeat group did not differ significantly from those in the routine gynecologic population (P = .69 and P = .33, respectively). However, the rates of dysplasia or combined abnormalities were significantly lower in the early-repeat group than in the routine gynecologic population (P = .02 and P = .003, respectively).

CONCLUSIONS

Less than optimal cervical cytologies occurred almost twice as often in obstetric as in gynecologic patients. Prenatal less than optimal test results were not associated with important cervical pathology, and repeat testing may safely be deferred until postpartum. In addition, early repeat testing in gynecologic patients is a low-yield procedure.