"Cancer was a speed bump in my path to enlightenment:" A qualitative analysis of situational coping experiences among young adult survivors of childhood cancer.

Young adult survivors of childhood cancer (N = 47) completed essays exploring situational coping within a mixed methods study. Data were qualitatively analyzed using consensual qualitative research-modified methodology. Five themes emerged: (1) initial reactions to cancer, (2) adjustment/coping with cancer diagnosis and treatment, (3) provisions of social support, (4) perceived effects of cancer experience, and (5) reflections on the cancer experience. Perceptions of childhood cancer experiences appear generally positive, with the majority of negative reactions emerging immediately following diagnosis. Cognitive behavioral and supportive interventions may be most beneficial in the initial postdiagnosis period and should emphasize lasting benefits, accomplishments, and profound effects.

Psychosocial Late Effects in Pediatric Cancer Survivors: A Report From the Children's Oncology Group.

BACKGROUND: This review was conducted to update the Children's Oncology Group (COG) Long-Term Follow-Up Guidelines (COG-LTFU Guidelines, version 4.0) regarding screening for psychosocial late effects of pediatric cancer. PROCEDURE: Articles published between August 2009 and January 2011 that addressed psychosocial late effects of long-term survivors of pediatric cancer (n = 35) were reviewed by a multidisciplinary team of COG late effect experts. RESULTS: The majority of studies in this time period indicate that survivors experience few psychosocial problems in long-term survivorship. A critical subset, however, is at increased risk for psychosocial late effects secondary to the treatment. Highlighted findings from this review include increased rates of suicidal ideation (SI), and health beliefs as robust predictors of SI, anxiety, and global distress. Survivors' health beliefs were associated with their perceptions of physical limitations, overall late effects, and cancer-related pain. While many survivorship studies continue to specify risk factors for anxiety and posttraumatic stress symptoms/posttraumatic stress disorder, others outcomes (e.g., developmental, interpersonal, and familial factors) appear to be emerging in importance. CONCLUSIONS: Although the majority of childhood cancer survivors do not experience psychosocial problems, a subset will. The recent research findings have been included in the new COG-LTFU Guidelines that will assist in the targeted assessment and the treatment of survivors' psychosocial health.

Relations among optimism, perceived health vulnerability, and academic, self-regulatory, and social self-efficacy in adolescent survivors of childhood cancer.

This study investigated relations among optimism, perceived health vulnerability, treatment intensity, and academic, self-regulatory, and social self-efficacy in adolescent survivors of childhood cancer. Fifty-six adolescent survivors (Mage = 16.19 years, SD = 2.48) completed questionnaires. Compared to a previously published sample of adolescents without a history of cancer, survivors reported similar academic, higher self-regulatory, and lower social self-efficacy. Optimism and health vulnerability were associated with changes in academic, self-regulatory, and social self-efficacy. Cancer-specific variables (e.g., treatment intensity, time since treatment ended) were unrelated to self-efficacy. Interventions aimed at enhancing self-efficacy may benefit from exploring optimism and health vulnerabilities as mechanisms for change.

Mediators of Social Acceptance Among Emerging Adult Survivors of Childhood Cancer.

Purpose: Examine associations of social developmental factors (e.g., peer/parent social attachment, romantic relationships) and perceptions of social acceptance among emerging adult survivors of childhood cancer. Methods: A cross-sectional, within-group design was used. Questionnaires included the Multidimensional Body-Self Relations Questionnaire, Inventory of Parent and Peer Attachment, Adolescent Social Self-Efficacy Scale, Personal Evaluation Inventory, Self-Perception Profile for Adolescents, and demographics. Correlations were utilized to determine associations between general demographic, cancer-specific, and the psychosocial outcome variables. Peer and romantic relationship self-efficacy were assessed as potential mediators of social acceptance in three mediation models. Relationships between perceived physical attractiveness, peer attachment, parental attachment, and social acceptance were assessed. Results: Data were collected from N = 52 adult participants (Mage = 21.38 years, standard deviation = 3.11 years) diagnosed with cancer as a child. The first mediation model demonstrated a significant direct effect of perceived physical attraction on perceived social acceptance and retained significance after adjusting for indirect effects of the mediators. The second model demonstrated a significant direct effect of peer attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer relationship self-efficacy. The third model demonstrated a significant direct effect of parent attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer self-efficacy. Conclusion: Relationships between social developmental factors (e.g., parental and peer attachment) and perceived social acceptance are likely mediated by peer relationship self-efficacy in emerging adult survivors of childhood cancer.

Fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy.

BACKGROUND: Adolescents with cancer experience distressing physical and psychosocial symptoms, especially during treatment. Fatigue and sleep disturbances commonly affect adolescents' quality of life, but little is known about how adolescents experience these symptoms during an early month of chemotherapy. This study measured fatigue, sleep disturbances, and quality of life in 20 adolescents over 1 month while they were receiving chemotherapy. METHODS: Multidimensional fatigue and quality of life were measured weekly with modules from the PedsQL Measurement Model, and sleep disturbances were measured with the General Sleep Disturbance Scale. RESULTS: Adolescents experienced increased severity of fatigue and sleep disturbances during the week after treatment. Common sleep-wake problems included daytime sleepiness, decreased alertness, and poor sleep quality. Fatigue and sleep-wake disturbances were related symptoms, and both symptoms were associated with various domains of quality of life. CONCLUSIONS: Fatigue and sleep-wake disturbances are significant problems for adolescents receiving chemotherapy and negatively affect the quality of life. Clinicians should routinely screen adolescent patients for fatigue and sleep disturbances and intervene to minimize their impact using pharmacologic and nonpharmacologic strategies.

Happiness and time perspective as potential mediators of quality of life and depression in adolescent cancer.

BACKGROUND: Given the increase in 5- and 10-year survival rates of children and adolescents diagnosed with cancer, current psycho-oncology literature is focusing on finding correlates and predictors to their positive psychosocial adjustment. The purpose of this study was to evaluate two potential mediators to adolescent cancer survivors' quality of life (QOL) and depressive symptomology. PROCEDURE: Adolescent cancer survivors (N = 50; 50% males; mean diagnosis age, 13.7; mean age at study, 20.2) were surveyed, testing the mediation effects of their happiness (Subjective Happiness Scale) and past-negative time perspective (Zimbardo Time Perspective Inventory) on QOL (PedsQL 4.0) and depressive symptomology (CES-D). Independent variables included gender and treatment intensity. RESULTS: Happiness significantly mediated the relationship between treatment intensity in both depressive symptomology (beta = -0.65, P < 0.05, CI = -2.46, -6.41) and QOL (beta = 0.54, P < 0.05, CI = 3.66, 9.01). A past-negative time perspective significantly mediated the relationship between gender and depressive symptomology (beta = 0.60, P < 0.05, CI = 3.34, 9.78). Survivors' gender was not associated with happiness and treatment intensity was not associated with time perspective. CONCLUSIONS: Happiness may be a more direct predictor of QOL and depression than the intensity of treatment for cancer. Also, thinking negatively about one's past may be a more direct predictor of depressive symptomology than being female. Therefore, interventions that cultivate happiness and reframe time perspective may be effective ways to improve survivors' QOL and decrease depressive symptoms-regardless of gender and intensity of treatment protocol.

A pilot exploration of symptom trajectories in adolescents with cancer during chemotherapy.

BACKGROUND: Chemotherapy is frequently administered in repetitive cycles. Adolescents with cancer have multiple symptoms related to chemotherapy, but knowledge of symptom trajectories across a cycle is limited. Examining trajectories over a cycle may reveal key periods to manage symptoms. OBJECTIVES: The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables. METHODS: Nine adolescents with cancer within 6 months of diagnosis participated. Data were collected by surveys, chart review, and biologic measures on days 1 and 2 of the cycle, 1 week later (nadir), and day 1 of the following cycle. To evaluate the trajectory, a simple random-effects repeated-measures analysis was computed. RESULTS: The significant trajectories were fatigue (P = .003), difficulty sleeping (P = .032), and nausea (P = .04). Most of the adolescents reported some anticipatory anxiety about receiving chemotherapy. Significant correlations between symptoms and biobehavioral variables included anticipatory anxiety and nausea (r = .86, P = .003), trait anxiety and fatigue (r = -0.82, P < .001), and stress and pain (r = 0.78, P = .039). CONCLUSIONS: Multiple symptoms were experienced across the cycle. Three symptoms displayed significant trajectories indicating that patterns of symptoms may be anticipated. IMPLICATIONS FOR PRACTICE: Pilot findings suggest that monitoring symptoms, stress, and anxiety across a cycle is important, not only during chemotherapy administration, but also prior to being admitted for chemotherapy.

Patterns of fatigue in adolescents receiving chemotherapy.

PURPOSE/OBJECTIVES: To describe patterns of fatigue in adolescents and the impact of fatigue during one month of chemotherapy, to explore variables that affect fatigue, and to explore the feasibility of collecting daily self-report data in this population. DESIGN: Longitudinal, descriptive. SETTING: Two pediatric oncology centers in central Virginia. SAMPLE: 20 adolescents with a variety of cancer diagnoses receiving chemotherapy. METHODS: Adolescents described daily fatigue for one month using rating scales and qualitative diaries. MAIN RESEARCH VARIABLES: Fatigue severity. FINDINGS: Adolescents commonly reported a peak in fatigue in the days immediately following chemotherapy administration. The most common pattern for adolescents who received chemotherapy on a schedule every three to four weeks was a "declining rollercoaster" pattern, with fatigue severity alternating on a daily basis but gradually declining until chemotherapy was scheduled again. Adolescents who received chemotherapy weekly showed more frequent peaks and troughs (the "yo-yo" pattern) that did not diminish in severity over the weeks of the study. Adolescents associated fatigue with other symptoms, particularly sleep-wake disturbances, pain, and nausea, and frequently reported that fatigue interfered with daily activities. CONCLUSIONS: Fatigue commonly bothers adolescents receiving chemotherapy, particularly in the days following chemotherapy administration and when other symptoms are present. Although fatigue interfered with the adolescents' abilities to maintain their usual lifestyles, many still participated in the typical activities of adolescence. IMPLICATIONS FOR NURSING: Fatigue is a complex and dynamic symptom. Oncology clinicians and researchers should frequently assess fatigue in adolescents receiving chemotherapy and apply timely and tailored interventions to match the factors that contribute to fatigue and influence fatigue severity. Management of fatigue during treatment will help adolescents stay involved in age-related activities and meet developmental milestones.