Sexuality, intimacy, and body image among adolescents and young adults with cancer: a qualitative, explorative study.

AIM: The aim of this study was threefold: (1) to explore Danish adolescents and young adults' (AYAs) thoughts concerning sexual health particularly focusing on sexuality, intimacy, and body image throughout a cancer trajectory, (2) to investigate how AYAs experience healthcare professionals address of- and respond to sexual health issues, and (3) to identify AYAs' suggestions on how to support conversation about sexual health. METHODS: A qualitative, single-center study was conducted, including AYAs (18-29 years) diagnosed with cancer recruited at the University Hospital of Copenhagen, Rigshospitalet. Individual semi-structured interviews were conducted from January-February 2023, recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS: Twelve participants were interviewed, aged 20-29; five were diagnosed with hematological- and seven with oncological cancer. Our analyses yielded three themes: (1) sexuality and body image as part of the identity, (2) excluding relatives in conversations about sexual health, and (3) uncertainty how to discuss sexual health with healthcare professionals. Finally, the AYAs' suggestions to support conversations about sexual health were organized into six thematic categories. CONCLUSION: In this study, participants experienced altered sexual subsequent impacts on body image and self-esteem during their cancer trajectory. While some adapted to these changes, discussing them with healthcare providers was difficult, especially in the presence of relatives, as the AYAs wanted to shield them from additional concerns. To enhance support, AYAs suggest regular discussions on sexual health and the use of a dialog tool by healthcare professionals.

Combined rehabilitation and palliative care interventions for patients with life-threatening diseases - PREGOAL. A scoping review of intervention programme goals.

PURPOSE: WHO recommends integrating rehabilitation into palliative care when providing services for people with life-threatening conditions. Recently, there has been increasing interest in exploring how rehabilitation and palliative care approaches could be combined. The aim of this study was to map and discuss the goals of intervention programmes that combine rehabilitation and palliative care. METHODS: A scoping review was performed. The electronic databases MEDLINE, EMBASE, and CINAHL were searched for papers published between January 2014 and September 2022. Papers were considered eligible if the participants in question had a life-threatening disease and if interventions included both rehabilitation and palliative care. All study types were included. RESULTS: Ten papers describing five interventions were included. Qualitative goals were narratively described, and quantitative goals were analysed according to the International Classification of Functioning, Disability and Health, and the Total Pain framework. Findings showed an overall focus on functioning and quality of life. Further analysis indicated an emphasis on physical and psychological dimensions. Social participation, and the social and spiritual dimensions were rarely evaluated. CONCLUSION: This review indicates that goals relative to social participation, the social and spiritual dimensions, and the patient's own goals may well be overlooked as points of orientation for interventions.

There is an increasing interest in combining palliative care and rehabilitation approaches in clinical work.When rehabilitation and palliative care are combined, goals may be overlooked, and the patient's own goals can be used as a point of orientation for interventions.Future practice should pay special attention to subjective goals, social participation, and the social and spiritual dimensions when combining rehabilitation and palliative care.

The 'Young Adult Taking Action' programme for young adult cancer survivors: A study protocol for a feasibility study.

BACKGROUND: Young adult cancer survivors (YACS) aged 18-39 report age-specific multifactorial challenges with self-care, leisure, work and education requiring multicomponent rehabilitation intervention. Therefore, the 'Young Adult Taking Action' (YATAC) programme was developed. AIMS/OBJECTIVES: To present a protocol for a feasibility study evaluating the acceptability of the YATAC programme and exploring implementation, mechanisms of impact and outcomes. MATERIAL AND METHODS: A mixed-method feasibility study with a convergent research design will be conducted. The programme is an age-specific, multicomponent, goal-oriented, and peer-based rehabilitation programme delivered by an interdisciplinary staff consisting of nine components: 1) Goal setting, 2) Everyday life, 3) Physical activity, 4) Psychological issues, 5) Work and study, 6) Sexuality and relationship, 7) Rights and finance, 8) Peer-to-peer support and 9) Individual consultation. Quantitative and qualitative data about acceptability, implementation, mechanisms of impact and outcomes will be collected. RESULTS: The results will provide essential knowledge about the programme's acceptability, implementation, mechanisms of impact and outcomes. CONCLUSION AND SIGNIFICANCE: The study will inform adjustment of the programme and will provide knowledge of whether and how to deliver age-specific rehabilitation to YACS.

Rehabilitation interventions for young adult cancer survivors: A scoping review.

OBJECTIVE: To map existing research concerning rehabilitation interventions for young adult cancer survivors (YACS) that address at least one factor from the biopsychosocial health model. DESIGN: Scoping review. DATA SOURCES: Searches were performed in EMBASE, MEDLINE, PsycINFO, CINAHL and Cochrane in January 2022 and updated in March 2023, and grey literature between February and April 2022. METHODS: The review followed Joanna Briggs Institute's methodology for scoping reviews. Quantitative, qualitative and mixed methods studies evaluating interventions for YACS of any cancer who had completed primary treatment and were between 18 and 39 years old at diagnosis were included. Two authors independently screened studies for eligibility, and standardised forms were used for data extraction. Descriptive statistics, narrative summaries and thematic analysis were used to analyse the data. RESULTS: The search revealed 5706 records, of which 70 were full-text screened. The 20 included studies represented a heterogeneous group of 444 young adults with different cancer types, mean age above 25, and an overrepresentation of females. Most studies were feasibility and pilot studies. The 20 studies consisted of 14 unique interventions focusing primarily on one dimension of the biopsychosocial health model like biological or psychological factors. In the 14 interventions, the most frequent intervention element was peer-to-peer support (n = 12). The interventions were often delivered online (n = 9), lasting 3-12 months (n = 8). A wide variety of theories, providers and outcome measures were used. CONCLUSION: The results show that current research on multicomponent, biopsychosocial and age-specific rehabilitation for YACS remains at an early stage.

Users' perspective on rehabilitation interventions for young adult cancer survivors: A group concept mapping study.

OBJECTIVE: We aim to identify and prioritise rehabilitation interventions to strengthen participation in everyday life for young adult cancer survivors (YACS) between 18 and 39 years, involving the perspectives of YACS and relevant stakeholders. METHODS: A group concept mapping study was conducted in Denmark from 2019 to 2020. Online, participants generated and sorted ideas followed by rating their importance. Multidimensional scaling followed by hierarchical cluster analyses were applied to generate a cluster rating map of the prioritised interventions, which participants validated at a face-to-face meeting. Finally, a concluding conceptual model of prioritised rehabilitation intervention for YACS was developed. RESULTS: The study involved 25 YACS, three family members and 31 professionals working with YACS. The conceptual model included 149 ideas classified into eight intervention components created by the participants: (1) Treatment and possibilities within the social and healthcare system, (2) Rights and Finance, (3) Education and Work, (4) Psychological problems, (5) Body and Everyday Life, (6) Peer-to-peer, (7) Sexuality and Relationships and (8) Family and Friends. All components were rated equally important, whereby 17 ideas across the eight components were rated very important. CONCLUSION: This study indicates that rehabilitation of YACS should be composed of eight equally important intervention components requiring an interdisciplinary approach.

Differences in functioning between young adults with cancer and older age groups: A cross-sectional study.

OBJECTIVE: This study aimed to explore whether young adults with cancer have different functioning compared to older age groups with cancer. METHODS: This study is a cross-sectional study including 654 adults (≥18 years) with cancer. Exposure was age groups categorised as (1) young adults (n = 121) = 18-39 years; (2) middle-aged adults (n = 406) = 40-64 years; and (3) older people (n = 127) = ≥65 years. Outcomes were physical, role, social and cognitive functioning. Analyses consisted of linear regression models. RESULTS: Middle-aged adults had a statistically significant worse physical functioning compared to young adults (-3.90: [95% CI: -6.84; -0.95]). The older age group also had a statistically significant worse physical functioning compared to young adults (-7.63: [95% CI: -11.29; -3.96]). Young adults had statistically significant lower role functioning (-7.11: [95% CI: -1.13; -13.08]) and cognitive functioning (-13.82: [95% CI: -7.35; -20.29]) compared to the older age group. There was no statistically significant difference in social functioning between the age groups. CONCLUSION: Young adults with cancer seem to have other functioning problems compared with higher age groups. These findings support current research regarding the need to develop age-specific and appropriate rehabilitation services for young adults with cancer.

The cumulated ambulation score is superior to the new mobility score and the de Morton Mobility Index in predicting discharge destination of patients admitted to an acute geriatric ward; a 1-year cohort study of 491 patients.

PURPOSE: To investigate the predictive value of New Mobility Score, de Morton Mobility Index, and Cumulated Ambulation Score regarding discharge destination, and to determine the feasibility of the tests in an acute geriatric ward. MATERIALS AND METHODS: Observational 1-year cohort study of 491 geriatric patients admitted consecutively from own home. New Mobility Score (pre-hospital functional level), de Morton Mobility Index, and Cumulated Ambulation Score were recorded at the first physiotherapy contact. RESULTS: Univariable logistic regression showed that the odds for not being discharged home were 7 times higher (odds ratio = 7.6, 95%CI; 4.5-12.7) for patients with a non-independent mobility level (Cumulated Ambulation Score ≤ 5) compared to independent (Cumulated Ambulation Score = 6). Corresponding ratios were 6.2 (3.8-10.0) for de Morton Mobility Index ≤ 41 points and 2.8 (1.8-4.5) for New Mobility Score ≤5 points. Adjustment for gender, age, cause of admission, and marital status improved the predictive value of the Cumulated Ambulation Score. Upon admission, 99% of the patients were assessed with New Mobility Score, 100% with Cumulated Ambulation Score, and 81% with de Morton Mobility Index. CONCLUSION: Cumulated Ambulation Score is more feasible and superior in predicting discharge destination than de Morton Mobility Index and New Mobility Score in an acute geriatric ward.Implications for rehabilitationEasy, quick, and accurate measurement of mobility is essential for discharge planning and effective targeting of physiotherapy in an acute geriatric ward.The objectively assessed Cumulated Ambulation Score is superior to the de Morton Mobility Index and the pre-hospital New Mobility Score in predicting discharge destination in geriatric patients admitted from their own home.The Cumulated Ambulation Score and the New Mobility Score are more feasible and less time consuming to complete in an acute geriatric ward compared to the de Morton Mobility Index.

Risk of being granted disability pension among incident cancer patients before and after a structural pension reform: A Danish population-based, matched cohort study.

Objective This study aimed to examine the risk of being granted a disability pension (DP) among incident cancer patients up to five years after diagnosis compared to a match control group, before and after the structural reform of the Danish Disability Pension Act in 2013. Methods All 20-60-year-old incident cancer-diagnosed individuals from 2000 to 2015 were identified in the Danish Cancer Registry. A control group, not previously diagnosed with cancer, was identified in Statistics Denmark matched by gender, age, education, and household income. Risk differences (RD) in cumulative incidence proportions of being granted a DP between cancer patients and controls were analyzed before and after the reform. Results In total, 111 773 incident cancer patients and 506 904 controls were included in the study. Before reform 10 561 cancer patients and 11 231 controls were granted DP; and 2570 cancer patients and 2646 controls were granted DP after the reform. The adjusted RD of being granted DP was significantly higher for cancer patients versus controls at all time points before the reform. The RD increased the most during the first (RD 3.6, 95% CI 3.5-3.7) and second (RD 7.2, 95% CI 7.0-7.4) follow-up year and levelled off the remaining three years. After the reform, the adjusted RD were lower for all 1-5 follow-up years compared to before the reform (RD range 2.8-7.7, 95% CI 2.6-8.1). Conclusion The 2013 reform of the Disability Pension Act reduced the risk of cancer patients being granted DP. The impact on a personal level should be further explored.

Reliability and agreement between 2 strength devices used in the newly modified and standardized Constant score.

HYPOTHESIS: The new and standardized test protocol for the Constant score (CS) provides new methodology, but different devices are still used for shoulder strength testing. It was hypothesized that strength measurements using the IsoForceControl (IFC) dynamometer (MDS Medical Device Solutions, Oberburg, Switzerland) would provide results comparable with the IDO isometer (Innovative Design Orthopaedics, Redditch, UK). MATERIALS AND METHODS: Sixty healthy subjects, aged 19 to 83 years, were studied, with 5 men and 5 women in each of 6 ten-year age groups. The IFC and IDO were used in randomized order with an 8-minute interval between testing. Subjects performed 3 successive trials with strong verbal encouragement, with 1 minute between trials. The best strength performance was used in the analysis. The rater and subjects were blinded to all results. RESULTS: The IFC produced 0.28-kg (0.62-lb) higher strength values on average than the IDO (P = .002). The intraclass correlation coefficient (ICC2,1) was 0.97 (95% confidence interval, 0.95-0.98), whereas the standard error of measurement and smallest real difference were 0.43 kg (0.95 lb) and 1.2 kg (2.63 lb), respectively. The total CS and strength reached mean values of 92.4 points (SD, 6.2 points) and 8.2 kg (SD, 2.6 kg) (18.0 lb [SD, 5.8 lb]), respectively, and were negatively associated with age (r > -0.407, P ≤ .001). The strength values decreased (P ≤ .001) by 1.3 CS points per decade, and women had strength values that were 8 CS points lower on average than those of men of the same age. CONCLUSIONS: The relative (intraclass correlation coefficient) and absolute (standard error of measurement) reliability between the IFC and IDO is excellent, indicating that performances reported from settings using the IDO are comparable with those recorded with the IFC in other settings.