Psychosocial interventions for childhood cancer survivors: Systematic review and meta-analysis of randomized control trials.

PURPOSE: This study was aimed to review and analyze the evidence of the psychosocial interventions for survivors of childhood cancer. METHODS: Electronic databases (PubMed, Embase, Medline, Web of Science, Science Direct, and Scopus) and manuel search were performed for psychosocial randomised controlled trials (RCTs) conducted with survivors who were diagnosed under the age of 18 and have completed treatment. Meta-analyses were performed to evaluate the effects of interventions on psychosocial health outcomes. The trials were published in English between 1 January 2000 to 30 June 2022 were included. Extracted data were analyzed using Review Manager 5.4. RESULTS: Ten trials conducted with 955 childhood cancer survivors were included in the systematic review. Meta-analysis of six RCTs showed no difference in the general quality of life (SMD, 0.07; 95% CI: [-0.09 to 0.23], I2 0%, (p > 0.05)) and three RCTs showed no difference in the physical activity self-efficacy (SMD, 0.12; 95% CI: [-0.35 to 0.58], I2 75%, (p > 0.05)) between intervention and control group. Interventions longer than 24 weeks (including follow-up) were effective in the quality of life and physical activity self-efficacy of the survivors. The overall quality of the evidence was low due to overall low risk of bias for only half of the studies (50%). CONCLUSIONS: Psychosocial interventions were not effective on quality of life and physical activity self-efficacy of childhood cancer survivors, however, long-term interventions provided improvement in these outcomes. REGISTRATION: The protocol for the meta-analysis was registered at PROSPERO (CRD42022375053/22 Nov 2022).

Qualitative Analysis of School Re-Entry Experiences of Turkish Survivors of Childhood and Adolescent Cancer: Parental Perspective.

OBJECTIVE: This study aimed to explore the school re-entry experiences of Turkish survivors of childhood and adolescent cancer. DATA SOURCES: In this qualitative study, semistructured in-depth interviews were undertaken with parents of childhood cancer survivors who had completed treatment for at least 2 years (n = 20). Interviews were conducted via telephone or video conferencing. The study was conducted and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. The components of qualitative rigor were considered to ensure confidence in the methods and data. CONCLUSIONS: The average age of parents was 43.20 ± 4.66 years (range 37-55) (n = 20). The mean age of survivors was 8.45 ± 2.03 years at diagnosis and 15.05 ± 2.08 years during the study. The diagnosis of most of the survivors was lymphoma (35%). Four main themes were developed: worry; challenging situations; negative effects of the disease process; and facilitating situations. Parents stated that both children and parents need support during the school re-entry process. IMPLICATION FOR NURSING PRACTICE: This study revealed that survivors may experience problems that make school re-entry difficult. With cooperation between the health team and the school, arrangements should be made to ensure survivors have a positive experience on school re-entry. Pediatric oncology nurses should know survivors' requirements and take action to deliver school re-entry adjustment programs.

The effect of psychological resilience and spiritual well-being on the experience of hope in parents of children with cancer.

PURPOSE: Hope in pediatric oncology guides parents as an inner guidance compass through their child's challenging journey toward cancer treatment. This study was designed to examine the effects of psychological resilience, spiritual well-being, and some child- and parent-related factors on parents' experience of hope while their child is undergoing cancer treatment. DESIGN AND METHODS: This cross-sectional, correlational study was conducted between March and July 2022 in the pediatric oncology-hematology ward of a university hospital in Turkey. Parents of 120 children with cancer were included in the study. Data were collected using the child and parent questionnaire, Herth Hope Index, Connor-Davidson Resilience Short Form, and Spiritual Well-Being Scale. Correlation and multiple linear regression analysis were used to analyze the data. In addition, the content analysis method was used to analyze the open-ended structured questions. Ethical approval was obtained for the study. RESULTS: In the study, 57.5% of the parents who participated were mothers. The mean age of the children was 9.46 ± 5.00 years. 30.8% of the children were diagnosed with Acute Lymphoblastic Leukemia, and the mean duration of treatment was 20.42 ± 13.75 months. According to multiple linear regression analysis, child gender (ß = -0.16), number of children (ß = -0.16), cancer diagnosis (ß = -0.24), resilience (ß =0.31), and parental spiritual well-being (ß =0.40) were the determinant factors affecting parents' experiences of hope. All these predictors explained 55% of the change in parents' hope levels. In addition, two main themes (increasing and decreasing factors) were identified regarding parents' experiences of hope. CONCLUSIONS: Insights from this study have the potential to shape interventions specifically designed to maintain parents' hope throughout their child's cancer treatment journey. IMPLICATIONS FOR PRACTICE: This study may provide insights for the design of intervention programs in pediatric oncology hematology wards aimed at strengthening the hope and improving coping mechanisms of parents with children coping with cancer.

Back to school readiness scale for children with oncological problems: 7-18 years of age.

INTRODUCTION: Childhood cancers are one of the important health problems in both developed and underdeveloped countries. The cancer treatment process is a difficult period that can last for months or years, interrupt school activities for a while, or even cause them to leave completely, and require long-term hospitalization. PURPOSE: This study was carried out to develop the Back to School Readiness Scale for Children with Oncological Problems: 7-18 years of age, and to establish its validity and reliability. METHOD: The research is a methodological study and the validity and reliability study of a developed scale was conducted. RESULTS: Kaiser-Meyer-Olkin (KMO) value was determined as 0.951. As a result of Bartlett's test analysis, Chi-Square value is 6261.566, degree of freedom is 703 and the value found is significant (p = 0.00, p < 0.05). While the loadings of the items on the first factor vary between 0.79 and 0.46, the loads on the second factor vary between 0.76 and.47. The item-total-test correlation value is 0.63. Total Croncabh alpha (α) value of the scale is 0.97. CONCLUSION: Back to School Readiness Scale for Children with Oncological Problems: 7-18 years of age is a valid and reliable measurement tool. PRACTICE IMPLICATIONS: Returning to school is a difficult process for children living with cancer due to long-term hospitalization. This scale can be used by both pediatric nurses and school nurses to evaluate children's return to school. Additionally, children and families can get an idea about preparing for returning to school by applying this scale.

Evaluation of the Effectiveness of a Technology-Based Psychosocial Education and Counseling Program for Adolescent Survivors of Childhood Leukemia: A Randomized Controlled Trial.

BACKGROUND: In addition to increased survivorship in childhood leukemia, a small but significant number of survivors experience psychosocial challenges that affect their health-related quality of life (QOL) that require interventions to address these challenges. OBJECTIVE: The aim of this study was to evaluate the efficacy of the technology-based, psychosocial education and counseling program on survivors' QOL, self-efficacy, and coping skills within the scope of a health promotion model for adolescent survivors of childhood leukemia. METHODS: The randomized controlled trial was conducted with adolescent survivors of childhood leukemia who were between the ages of 12 and 18 and had completed treatment at least 2 years previously. Survivors were randomized to a technology-based intervention (n = 24) or a control group (n = 31). Survivors' QOL, self-efficacy, and coping skills were measured at 4 time points (baseline, postintervention, 1 month postintervention, and 3 months postintervention). RESULTS: The 3-month postintervention QOL total and psychosocial subscale scores in the intervention group were significantly higher than those in the control group ( P < .05). In addition, the emotional self-efficacy subscale scores and the active coping scores of the intervention group adolescents were significantly higher than those in the control group ( P < .05). Negative coping scores were lower in the intervention group than in the control group ( P < .05). CONCLUSION: Technology-based, psychosocial counseling and education positively affects the QOL, emotional self-efficacy, and coping skills of adolescent survivors of childhood leukemia. IMPLICATIONS FOR PRACTICE: This program could be integrated into follow-up care and used as one of the support methods in providing and maintaining long-term follow-up care by pediatric oncology nurses.

'Trying to catch up with life': The expectations and views of adolescent survivors of childhood acute lymphoblastic leukaemia about long-term follow-up care: A qualitative research.

OBJECTIVE: The aim of this study was to explore adolescent survivors' views and expectations about long-term follow-up care. METHODS: Semi-structured, in-depth interviews were conducted with 16 adolescent survivors of childhood acute lymphoblastic leukaemia. Survivors who had completed treatment at least 2 years ago were involved in the study. Interviews were audio-recorded and transcribed verbatim. An inductive thematic approach was used to analyse the data. RESULTS: Four main themes and sub-themes were identified from the analysis as follows: information needs with three sub-themes 'long-term follow-up, healthy life and social life', support needs with three sub-themes 'psychosocial (peer relations etc.), school related and social-emotional (fear of relapse, body image, self-esteem, etc.)', perceived benefits with two sub-themes 'social-emotional and related to long-term follow-up' and perceived barriers 'medical-hospital related and social life'. CONCLUSIONS: Adolescent survivors mainly need support in terms of psychosocial aspects: self-esteem-body image, school, peer relations and social activities during follow-up. Identified barriers related to follow-up were school absence and not able to participate social activities. Adolescents specify health promotion approaches as benefits aspects of follow-up. The findings of this study will guide nurses in the long-term follow-up care of adolescent survivors of acute lymphoblastic leukaemia and provide an opportunity to plan individualised follow-up care.

New Trends and Recent Care Approaches in Pediatric Oncology Nursing.

Increased incidence of children diagnosed with cancer and survivors was an impact on changes in pediatric hemato-oncology nursing care. In this review article, it is aimed to investigate the new trends and recent care approaches in pediatric oncology nursing. The recent care topics were common in the literature as family-centered care, technology-based care, program development, primary care of child, health-care provider, survivors and home care, and nonpharmacological care. All of the topics contribute to perform evidence-based care for health promotion and well-being in pediatric hemato-oncology nursing. Research reviews showed that many current topics for the care of children and their parents have entered in the literature. There is a need for more randomized controlled studies to improve the level of evidence of new nursing approaches.

Assessment of Nutritional Problems in Pediatric Patients with Cancer and the Information Needs of Their Parents: A Parental Perspective.

OBJECTIVE: The majority of problems and symptoms occur in the gastrointestinal system in children with cancer. Parents have difficulty in coping with the nutritional problems and changing routines of children and need support in this respect. This study aimed to assess the nutritional problems of children with cancer and the information needs of their parents. METHODS: This descriptive study was performed among children with cancer aged 3-18 years and their parents (n = 69). The data were collected through a data collection form developed by the researchers based on the literature. RESULTS: The most prominent nutritional problems experienced by children were loss of appetite (85.5%), nausea (84.1%), vomiting (81.2%), fatigue (79.7%), and mucositis (66.7%). According to the parents, the factors causing these nutritional problems in children were physiological factors (100%) and the foods given to children in the hospital (65.2%). The parents mostly needed information about food-drug interactions (58.0%), food-disease interactions (52.2%), foods that children with neutropenia should avoid or should eat (neutropenic diet) (46.4%), and frequency of nutritional intake (36.2%). CONCLUSIONS: This study has shown that most children experience at least one nutritional problem, and the parents need comprehensive and regular information about nutrition. Pediatric oncology nurses have a significant responsibility in the evaluation, education, and monitoring of these children.

Effect of parental depression level on children's quality of life after haematopoietic stem cell transplantation.

PURPOSE: This descriptive cross-sectional study aimed to determine the impact of parental depression level on children's quality of life after haematopoietic stem cell transplantation (HSCT). METHOD: This study was conducted in a bone marrow transplantation unit of a children's hospital in Ankara, Turkey. The research sample consisted of 82 parents. Children aged 2-18 years and monitored in polyclinics 100 days after HSCT were included in the study. A sociodemographic data form, parent forms of the Pediatric Quality of Life Inventory, and the Beck Depression Inventory (BDI) were used. RESULTS: Forty (48%) mothers and 42 (51.2%) fathers participated in the study. Of the children, 30 (36.6%) were female and 52 (63.4%) were male, and their mean age was 10.68 [standard deviation (SD) 4.80] years. Twenty-six children (31.7%) had been diagnosed with thalassaemia, and 29 children (35.4%) had undergone HSCT in the previous 25-36 months. The mean total scale score on the Pediatric Quality of Life Inventory was 61.37 (SD 21.85), and the mean parental BDI Score was 14.57 (SD 11.03). Fourteen (17.1%) parents had severe depression and 10 (12.2%) parents had moderate depression. Low statistical correlation was found between the parental BDI score and the total scale score on the Pediatric Quality of Life (r = -0.281; P = 0.011). CONCLUSION: Parental depression level affects children's quality of life after HSCT. Following transplantation, it is important to evaluate parental depression level and provide support.

The effect of drawing and writing technique on the anxiety level of children undergoing cancer treatment.

PURPOSE: To determine the effect of the drawing and writing technique on the anxiety level of children undergoing cancer treatment in hospital. METHOD: Research was conducted in the haematology-oncology clinic of a university hospital, using a quasi-experimental design (pre-and-post intervention evaluations of a single group). The sample comprised 30 hospitalised children aged 9-16 years. Data were collected with Socio-demographic form, clinical data form, and the State Anxiety Inventory. The institution gave written approval for the study and parents provided written consent. Drawing, writing and mutual story-telling techniques were used as part of a five-day programme. Children were asked to draw a picture of a hospitalised child and write a story about this drawing. After drawing and writing, mutual storytelling were used to more constructive story with positive feelings. The drawing, writing techniques was implemented on the first and third days of the programme and mutual storytelling was implemented on the second and fourth days. Data were reported as percentages and frequencies and the intervention effect analysed with the Wilcoxon test. RESULTS: The average age of children was 12.56 years ± 2.67 and 76.7% were girls. The mean age diagnosis and mean treatment duration were 11.26 years ± 3.17 and 16.56 months ± 20.75 respectively. Most of the children (50%) had leukaemia and were receiving chemotherapy (66.7%). In most cases (76.7%) the mother was the primary caregiver. Scores on the State Anxiety Inventory were lower-indicating lower anxiety-after the intervention (36.86 ± 4.12 than before it (40.46 ± 4.51) (p < 0.05). CONCLUSION: The therapeutic intervention reduced children's state anxiety.

Determination of smoking and drinking and preventive measures in adolescents.

Smoking and alcohol drinking in adolescents cause significant problems in most countries. The aim of this cross-sectional descriptive study was to determine the prevalence, causes, risk factors, and preventive factors for cigarette and alcohol use in adolescents. The sample included 1,133 students enrolled in grades 9-12. Data were collected using a descriptive data form, the Psychological Resilience and Adolescent Development Scale, and the Family Environment Scale. Most adolescents stated that stress and psychological problems were the causes of smoking and alcohol use. Preventive factors were indicated as developing skills for saying "no," good coping skills, and peer groups not using cigarettes. The Psychological Resilience and Adolescent Development Scale mean score for cigarette and alcohol use was significantly higher than for nonuse. The Family Environment Scale mean score for cigarette and alcohol use was significantly lower than for nonuse.

Determination of social support needs and expectations of mothers of children with cancer.

The aim of this study was to determine the social support needs of mothers of children with cancer and their expectations regarding nurses. The sample consisted of 88 mothers of children aged 0 to 18 years. The data were collected by a questionnaire and the Multidimensional Scale of Perceived Social Support (MSPSS) was used. The variables were investigated using visual methods (histograms and probability plots) and the Mann-Whitney U, Kolmogorov-Smirnov, Kruskal-Wallis, and Spearman tests. All the mothers stated that they needed social support but only 73.9% received it. Support was obtained mostly from families (83.0%), physicians (44.6%), nurses (38.4%), friends (30.7%), and neighbors (24.6%). Most of the social support was emotional (76.9%) and informational (49.2%). A total of 54.5% of the mothers expected social support from nurses. The mean total MSPSS score was 51.18 ± 25.30. In conclusion, all mothers felt that they needed social support, but their rate of receiving social support was lower than their needs.

A comparison of emotional indicators and depressive symptom levels of school-age children with and without cancer.

This study aims to compare the emotional indicators and depressive symptom levels of 6- to 12-year-old children with and without cancer. The sample included 20 children with cancer and 20 healthy children of similar ages and gender. Data were collected by using the Child Introduction Form, Children's Depression Inventory, the Human Figure Drawing test, and children's drawings. The results showed that the depressive symptom levels of children with cancer were significantly higher than those of healthy children. Impulsivity, mistrust, and anger were observed significantly more in children with cancer (P < .05). Although anxiety was equal in the two groups, shyness was observed more in the cancer group, though the difference was not significant (P > .05). The emotional indicators of both groups of children did not have an effect on their depression scores.