Losing a part of life: experiences of cancer survivors accessing treatment and sheltering in place during the COVID-19 pandemic.

PURPOSE: To explore experiences of sheltering in place and accessing treatment during the initial stages of the COVID-19 pandemic among survivors with cancer receiving tyrosine kinase inhibitor (TKI) therapy. METHODS: Participants from two pilot studies evaluating TKI therapy use in the Southeastern United States during the start of the COVID-19 pandemic (March 2020) were interviewed. Identical interview guides were used across both studies to assess participants' experiences accessing cancer treatment, sheltering in place, and coping during the COVID-19 pandemic. Digitally recorded sessions were transcribed professionally and checked for accuracy. Descriptive statistics were used to summarize participant sociodemographics, and a six-step thematic approach was used to analyze interview data and identify salient themes. Dedoose qualitative research software was used to manage and organize qualitative codes, themes, and memos. RESULTS: Participants (n = 15) ranged from 43 to 84 years of age, and were mostly female (53.3%), married (60%), and survivors with hematologic malignancies (86.7%). The research team identified five salient themes: Participants followed pandemic guidelines, Variable impact on well-being, Common feelings of fear, anxiety and anger, No barriers to accessing therapy and medical care, and Faith and God as powerful forces for coping. CONCLUSIONS: The conclusions of the study provide several implications for survivorship programs or clinics for supporting survivors who are taking chronic TKI therapy during COVID-19, including enhancement of current psychosocial support efforts for cancer survivors or development of new programs tailored to the unique needs of a survivor during a pandemic, such as focused coping strategies, modified physical activity programs, family/professional role changes, and access to safe public spaces.

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs.

OBJECTIVE: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics. METHODS: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention-related characteristics, and conducted subsequent stratified analyses for significant moderator variables. RESULTS: PSI significantly improved QoL (ß = 0.14,95%CI = 0.06;0.21), EF (ß = 0.13,95%CI = 0.05;0.20), and SF (ß = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. CONCLUSIONS: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention-related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses.

PURPOSE: This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS: Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS: CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (ß = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (ß = -0.16,95%CI = -0.25;-0.07) and anxiety (ß = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS: CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.

Quality of life and lymphedema following breast cancer.

The aim of the study was to compare Quality of Life (QOL) of breast cancer patients with and without secondary lymphedema (SLE) using a cross-sectional design with a convenience sample. Research packets were mailed to 2088 breast cancer patients (BrCaPt). The QOL component of the study used the Quality of Life Instrument --Breast Cancer Patient Version for data collection. The sample (n = 537) was 12.9% African-American/Hispanic/Other (AA) and 87.1% European-American (EA). One hundred and twenty-two women (22.7%) reported SLE. Overall and subscale means were computed and ANOVA was determined for seven variables: age, marital status, educational level, race, type of surgery, time since diagnosis, and SLE. Women without SLE had a higher overall mean QOL score compared to women with SLE (p= 0.02). Women with a greater than high school education had a higher mean QOL score compared to women with high school or less education (p=0.05). SLE patients had poorer QOL in the physical (p<0.001), and social (p=0.004) subscales. Older women had a higher overall QOL compared to younger women (p<0.001). These results provide insight into the impact of SLE on women's QOL and pinpoint that physical and social well being are negatively influenced by SLE.

Adolescents with cancer. Sexual and reproductive issues.

Adolescents with cancer are confronted with sexual and reproductive issues at diagnosis, during the entire treatment period, and as long-term survivors. To help the patient cope effectively with his/her concerns, the nurse must understand normal sexual growth and development, current trends in adolescent sexuality, and specific problems arising from diagnosis and treatment. This article discusses an overview of sexuality in the well adolescent, using research findings and anecdotal accounts. The impact of the diagnosis on the adolescent's emerging sexual identity is explored in depth. Information is given on the impact of long-term effects on both sexuality and reproduction. Finally, nursing interventions for helping adolescent cancer patients cope with both the impact of diagnosis and late effects are given. These interventions include collaboration with parents, relationship building, assessment, anticipatory guidance, education, and counseling.

Lasting impressions. A psychosocial support program for adolescents with cancer and their parents.

Adolescents with cancer undergo numerous stresses due to their disease, its treatment, and its potential late effects. These patients may experience delayed mastery of developmental tasks, intimacy, and independence and may have long-term psychological sequelae. Parents of adolescents with cancer also encounter many stresses related to coping with their child's illness. Lasting Impressions, a support program for adolescent cancer patients and their parents, was developed to help overcome these problems. The purpose of the program is to promote positive mental health and adaptation in participants. This article describes the program's goals and methods for accomplishing them, including components and therapeutic activities. The activities include a scrapbook, a newsletter, peer visitation, and a speakers' bureau. The most recent project is a video that is shown to newly diagnosed cancer patients. This program could be easily replicated by other oncology nurses who work with adolescents or young adults with cancer.

Strategies for organizing and maintaining successful support groups.

Nurses often become involved in organizing and leading support groups either through needs in their institutions or at the request of consumers interested in forming self-help groups. Nurses without formal training in group therapy may find it difficult to organize and maintain support groups. Successful strategies, based on group therapy techniques and project management skills, can assist group leaders in organizing a group "from scratch" or in revitalizing existing groups.

Good grieving--an intervention program for grieving children.

PURPOSE/OBJECTIVES: To describe a program for grieving children including the agenda, activities, and logistics of organizing the program. DATA SOURCES: Clinical observations and evaluations from the program; literature review. DATA SYNTHESIS: A series of four seasonal programs were designed to promote a child's normal grieving process and enhance adjustment to the loss. Programs are cyclic, children are grouped by age, and activities are intended to promote expression of feelings, understanding of the loss, and good coping skills. A concurrent program for caregivers facilitates family communication and support. CONCLUSIONS: The program demonstrated positive behavioral changes in grieving children and provides a model for other nurses to use in organizing similar programs. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be familiar with key elements of children's grief and incorporate this into their practice, especially when caring for terminally ill patients who have children.

The aftermath of bone marrow transplant for parents of pediatric patients: a post-traumatic stress disorder.

PURPOSE/OBJECTIVES: To describe the characteristics of a child's bone marrow transplant (BMT) experience that may precipitate a post-traumatic stress disorder (PTSD) in the parent. DATA SOURCES: Published articles, books, and the authors' clinical experience. DATA SYNTHESIS: When viewed from the PTSD framework, parental reactions to a child's BMT offer striking parallels that include assessment of the event as traumatic, re-experiencing the event, intrusive thoughts, and a variety of emotional and cognitive responses. Interventions based on PTSD research can be implemented in clinical settings to diminish and treat these responses. CONCLUSIONS: The PTSD framework holds promise for healthcare providers in devising strategies to help families of children undergoing BMT to cope with the experience. IMPLICATIONS FOR NURSING PRACTICE: Nurses can use orientation, education, coaching, and peer support to help families before BMT and debriefing and counseling after BMT.

Impact of parental anxiety on child emotional adjustment when a parent has cancer.

PURPOSE/OBJECTIVES: To describe the relationships among parent anxiety, child anxiety, and emotional adjustment in children who have a parent with cancer. DESIGN: Correlational. SETTING: A large cancer center in the southeastern United States. SAMPLE: Thirty-three child/parent with cancer dyads. METHODS: Research packets were mailed to child/parent dyads who agreed to participate in the study. Parents completed a demographic questionnaire, a Spielberger State-Trait Anxiety Scale, and a Personality Inventory for Children (PIC). Children completed the child version of the Spielberger State-Trait Anxiety Scale. MAIN RESEARCH VARIABLES: Parent anxiety, child anxiety, and child adjustment. FINDINGS: Children who have a parent with cancer and parents who have experienced cancer report significantly higher state and trait anxiety compared to a normed population sample. Parental reports on the PIC indicated that latency-aged children (i.e., 6-12 years) showed significantly greater internalization and somatic symptoms compared to the sample norm. Parent state anxiety was negatively correlated with children's internalization and somatic symptoms. Parental anxiety accounted for the greatest variance in child adjustment. IMPLICATIONS FOR NURSING PRACTICE: These study findings may provide nurses with a better understanding of the vulnerability of children who have a parent with cancer and can build a foundation for the development of supportive interventions for these children.

Sibling grief: a case report.

The intensity of sibling grief and the significance of sibling mourning are described in research studies. Yet, nurses caring for dying children may be unaware of these findings and may not offer adequate support to assist siblings in working through grief. This article details one child's perceptions of the loss of a brother and provides rich clinical material for understanding typical sibling responses. The description of the therapy sessions provides a model for working with siblings and demonstrates the value of art as a therapeutic medium. These strategies are useful for nurses working with grieving siblings and may be applicable to other situations in which children experience a significant loss.

Storytelling as a therapeutic technique in a group for school-aged oncology patients.

Storytelling in a support group may be a useful technique for helping children with chronic illness resolve psychological conflicts related to their illness. This paper will describe the author's experiences with two open-ended groups for children with cancer. Significant stories that demonstrate the technique and its usefulness will be discussed. Implications of such a technique will be given. The technique is adaptable to many settings and with many different diagnoses.

Developing, implementing, and evaluating a handbook for parents of pediatric hematology/oncology patients.

This article details the development of a parent handbook for pediatric hematology and oncology patients. The planning and content development are discussed. Adult learning principles were incorporated throughout the handbook. Use of the handbook in a pediatric cancer center is described. Both subjective and objective methods were used to evaluate the handbook. Results from the evaluation verify the value of the handbook to parents and give direction for future revisions of the handbook.

Cancer in adolescents and young adults. Psychosocial concerns, coping strategies, and interventions.

Adolescent cancer patients present a unique challenge to health care professionals because of the impact of the disease and its treatment on the successful acquisition of age-appropriate developmental milestones, as well as the psychosocial concerns raised by the illness itself. Understanding normal adolescent development provides a framework for identifying psychosocial concerns, predicting problems, and developing appropriate interventional strategies for adolescents with cancer. A comprehensive support program with specific goals of promoting adjustment to the illness and providing a basis for community reentry by strengthening recognized coping strategies based on identified psychosocial concerns is described as a model.

Quest. An intervention program for children whose parent or grandparent has cancer.

PURPOSE: The emotional strains and anxiety experienced by a family system when a parent or significant adult member has cancer are well documented. Furthermore, the literature suggests a need for an intervention program for children whose parent or grandparent has cancer. The current article describes Quest, an intervention program for children and teenagers whose parent or grandparent has cancer. Quest is designed to facilitate positive coping with a parent's or grandparent's cancer diagnosis, increase understanding about cancer, and promote more positive communication about the diagnosis within the family system. DESCRIPTION OF PROGRAM: Quest is a 2-hour, biannual evening program targeted to children and adolescents whose parent or grandparent has cancer and structured to include educational information as well as time for expression of feelings. RESULTS: The child, parent, and staff evaluations have been overwhelmingly positive and indicate the value of the program. CLINICAL IMPLICATIONS: This program might be useful to other clinicians who have limited time to address a small, but important population affected by a cancer diagnosis in a family member. The structure and organization of the program make efficient use of time, yet address major issues affecting the children.

Healing Icons: art support program for patients with cancer.

OBJECTIVES: The purpose of this report is to describe the structure and process of an art support program for patients with cancer who are age 16 and older. MATERIALS AND METHODS: Healing Icons is a six-session art support program for cancer patients. During the program participants create a three-dimensional mixed-media art piece to convey a unique personal perspective on receiving a diagnosis of and being treated for cancer. Concurrently, the patients spontaneously share common experiences about their cancer, which leads to strong emotional bonds. The purpose and goals of the program, method of implementation, and evaluation are described. Information and suggestions that clinicians might find useful in developing similar programs are discussed. Patient participants, their families, and staff in the cancer center have reported positive clinical evaluations. CONCLUSIONS: The benefits of Healing Icons are derived from the therapeutic factors present in a traditional support group blended with the creative process. This kind of program opens new avenues for expressing feelings and thoughts but should be structured in such a way that group processes are not allowed to negatively impact participants. Healthcare professionals interested in collaborating with artists on similar programs for cancer patients may approach artists through local art councils, art schools, and artists guilds. Brainstorming sessions with artists would help to capitalize on the expertise of artists within the community. Initiating a pilot project would help gauge patient interest and would provide valuable feedback from the healthcare team. Research is needed to validate the clinical outcomes derived from this program, as empirical findings would greatly enhance the clinical evaluations.