A Psychosocial Support Program for Young Adult Childhood Cancer Survivors in Austria: a Qualitative Evaluation Study.

Many adolescents and young adult (AYAs) childhood cancer survivors face disease- or therapy-related late-effects, which limit their participation in various areas of daily life. AYAs are often left alone in our health care system, and many worry about their ability to cope with long-term sequelae, and some are even lost to follow-up. Therefore, in the present study, a targeted aftercare program was developed and evaluated with the goal of facilitating three important "life skills": (1) self-perception, (2) social interaction and conflict management, and (3) self-conscious communication of support needs. A total of n = 13 participants (19.2-30.2 years, mean age 22.8 years) completed a 3-day aftercare seminar, at the end of which each participant wrote a reflection letter ("letter to my future self"), elaborating on observed effects of the seminar, applicability of the given information in daily life, and the direct impact of the seminar on their individual circumstances. The reflection letters were analyzed using qualitative content analysis. All target life skills were mentioned in the reflection letters. The participants reported individual benefits from the program especially with respect to self-perception and self-confidence, giving and taking feedback, and acceptance of personal strengths and weaknesses. Moreover, the feeling of "not being alone" was associated with the survivors' experience of emotional and social support. This evaluation highlights the potential of a one weekend aftercare seminar to address important life skills that are known to positively influence health behavior in AYAs. The detailed description of the seminar can serve as a basis for making this kind of aftercare accessible for other people in similar circumstances.

Drivers of COVID-19 Vaccine Intent Among Survivors of Adolescent and Young Adult Cancer: a Mixed Method Study.

BACKGROUND: Survivors of adolescent and young adult (AYA) cancer are susceptible to severe COVID-19 outcomes due to their cancer history. Drivers of COVID-19 vaccine hesitancy and willingness are largely unexplored among AYA cancer survivors. METHODS: We surveyed survivors of AYA cancer from October 2020-February 2021 who received services through an AYA cancer care program. Survey measures included vaccine hesitancy on a five-point Likert scale and an open-ended question on vaccine intent. Open-ended responses were content analyzed through two cycles of structured coding. Quantitative vaccine intent and qualitative drivers of intent were integrated during data analysis. RESULTS: Of participants who responded to the open-ended vaccine intent question (N = 300), 39.0% reported COVID-19 vaccine hesitancy. Qualitative content analysis resulted in N = 517 codes and seven content categories. The most common content category associated with hesitancy included COVID-19 vaccine development, approval, and efficacy (34.5%; p value ≤ 0.001), as well as content areas including presence of misinformation about COVID-19 in the response (4.8%; p value = 0.04), the desire for more information about COVID-19/COVID-19 vaccine (6.0%; p value ≤ 0.001), and reference to political influence on participants' intent to get the vaccine (2.5%; p value = 0.005). The most common category associated with vaccine willingness was personal perceptions of COVID-19 vaccination including protecting oneself and others (36.6% of codes; p value ≤ 0.001), followed by pro-vaccine beliefs (8.3%; p value ≤ 0.001) and trust in science (3.9%; p value ≤ 0.001). CONCLUSIONS: Common drivers of COVID-19 vaccine hesitancy among survivors of AYA cancer include concern about vaccine side effects and approval process, and misinformation. Cancer survivors COVID-19 vaccine uptake could be improved by focusing communication on drivers of willingness, motivational interviewing, and physician recommendations.

The Legacy of Shame following Childhood Sexual Abuse Disclosures.

Shame has been recognized as a barrier to child sexual abuse (CSA) disclosures, but there has been less focus on the impact of shame on post-disclosure. This study explores how shame is experienced by CSA survivors following disclosure. Semi-structured interviews were conducted with eleven CSA survivors aged 14-25 years on their CSA disclosure experiences. Thematic analysis of the transcripts produced four themes that highlight the various impacts of shame post-disclosure: 1) struggles with identifying as a sexual abuse survivor; 2) manifestations of shame; 3) shaming responses to disclosures; and 4) strategies to overcome shame. Clinical implications are presented using a social ecological perspective.

Cardiac Magnetic Resonance Imaging Findings in 2954 COVID-19 Adult Survivors: A Comprehensive Systematic Review.

BACKGROUND: Recent studies have utilized MRI to determine the extent to which COVID-19 survivors may experience cardiac sequels after recovery. PURPOSE: To systematically review the main cardiac MRI findings in COVID-19 adult survivors. STUDY TYPE: Systematic review. SUBJECTS: A total of 2954 COVID-19 adult survivors from 16 studies. FIELD STRENGTH/SEQUENCE: Late gadolinium enhancement (LGE), parametric mapping (T1-native, T2, T1-post (extracellular volume fraction [ECV]), T2-weighted sequences (myocardium/pericardium), at 1.5 T and 3  T. ASSESSMENT: A systematic search was performed on PubMed, Embase, and Google scholar databases using Boolean operators and the relevant key terms covering COVID-19, cardiac injury, CMR, and follow-up. MRI data, including (if available) T1, T2, extra cellular volume, presence of myocardial or pericardial late gadolinium enhancement (LGE) and left and right ventricular ejection fraction were extracted. STATISTICAL TESTS: The main results of the included studies are summarized. No additional statistical analysis was performed. RESULTS: Of 1601 articles retrieved from the initial search, 12 cohorts and 10 case series met our eligibility criteria. The rate of raised T1 in COVID-19 adult survivors varied across studies from 0% to 73%. Raised T2 was detected in none of patients in 4 out of 15 studies, and in the remaining studies, its rate ranged from 2% to 60%. In most studies, LGE (myocardial or pericardial) was observed in COVID-19 survivors, the rate ranging from 4% to 100%. Myocardial LGE mainly had nonischemic patterns. None of the cohort studies observed myocardial LGE in "healthy" controls. Most studies found that patients who recovered from COVID-19 had a significantly greater T1 and T2 compared to participants in the corresponding control group. DATA CONCLUSION: Findings of MRI studies suggest the presence of myocardial and pericardial involvement in a notable number of patients recovered from COVID-19. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 3.

An exploratory comparison of resilience profiles of Swiss older adult survivors of child welfare-related maltreatment and controls.

Child welfare practices in the last century have been linked to a high risk for child maltreatment and the subsequent development of mental ill-health. However, not all affected individuals develop clinically relevant psychopathology, which can be considered as a form of resilience. Such resilience is insufficiently understood in survivors of an advanced age. Therefore, this exploratory study aimed to depict a resilience profile of Swiss older adult survivors of child welfare-related maltreatment (n = 132; Mage = 71 years) and to contrast it with age-matched controls (n = 125). Approximately 30% of survivors did not meet the diagnostic criteria for any of the assessed current or lifetime DSM-5 disorders. These survivors were older, experienced less physical abuse, and had higher trait resilience, self-esteem, income, and satisfaction with their socio-economic status. They had lower levels of neuroticism and some empathy characteristics. Group differences in the resilience profiles suggest that resilience-related aspects may vary as a function of past adversity.

The Lived Experience of Human-Pet Relationships among Adult Survivors of Childhood Sexual Abuse: An Interpretative Phenomenological Analysis.

Given the high prevalence and severe consequences of childhood sexual abuse, it is essential to identify ways to support adult survivors. One potential and relatively unexplored resource available to survivors is the human-pet relationship. In the literature, the human-pet relationship is linked to many positive benefits to physiological regulation, mental health, physical health, and social support - areas of functioning where survivors of childhood sexual abuse may be particularly at risk. Despite existing evidence, there is little research on human-pet relationships among survivors of childhood sexual abuse. To help address this gap, this qualitative study explored the lived experience of human-pet relationships among adult survivors of childhood sexual abuse. Utilizing data collection and analysis methods from Interpretative Phenomenological Analysis, semi-structured interviews were conducted with 10 adult survivors of childhood sexual abuse. The following themes were developed from the data: (a) close bond with pet; (b) idiosyncrasies within the human-pet relationship; (c) moral responsibility; (d) fundamental differences between pets and humans; (e) safety in the human-pet relationship; (f) resource for coping with painful experience; (g) positive impact on well-being; (h) buttress for human-human social interaction; (i) medium for skill and knowledge development; and (j) shortcomings of the human-pet relationship. Findings are discussed in the context of the existing literature, along with considerations for practice and future research with childhood sexual abuse survivors.

National estimates of mental health service use and unmet needs among adult cancer survivors.

BACKGROUND: Cancer survivors are at elevated risk for developing mental health (MH) disorders. This study assessed MH service use and unmet service needs among a nationally representative sample of cancer survivors. METHODS: Respondents aged 18 to 64 years were identified from the 2015-2018 National Survey of Drug Use and Health data. Outcomes assessed past-year MH service use and self-reported unmet MH needs. Outcomes were compared between respondents who reported a cancer history (survivors) and those who did not (controls), descriptively and in adjusted analyses controlling for sociodemographic factors and health status. Analyses were stratified by age groups (18-34, 35-49, and 50-64 years). RESULTS: Comparing 3540 survivors with 149,843 controls, within each age group, a higher proportion of survivors than controls received any MH service (P values < .05); this difference persisted among those aged 35 to 49 years (P = .004) in fully adjusted models. Moreover, a higher proportion of survivors than controls reported an unmet need for MH care; this difference was larger among young adults aged 18 to 34 years (20.8% vs 9.0%; P < .001) than those aged 35 to 49 years (9.4% vs 5.3%; P < .001) and 50 to 64 years (4.8% vs 3.4%; P = .029). In fully adjusted models, the survivor-control difference in self-reported unmet MH needs persisted among young adults (24% relative increase; P = .023). Among cancer survivors, young adult survivors had the highest likelihood of reporting unmet MH needs. CONCLUSIONS: This nationally representative study found an increased perception of unmet needs for MH care among cancer survivors, particularly among young adult survivors, compared with the general population without cancer.

Childhood trauma determines different clinical and biological manifestations in patients with eating disorders.

PURPOSE: There is a significant relationship between childhood trauma and the development of an eating disorder in adolescence or adulthood, possibly influenced by circulating levels of inflammatory parameters. The main objective is to identify and describe a subgroup of patients with eating disorders and a history of trauma in childhood or adolescence with differential clinical features. METHODS: An observational study on a sample of 55 patients who met the diagnostic criteria for any DSM-5 eating disorder was carried out. Inflammatory parameters in white blood cells were examined. Patients underwent different assessments, including clinical and personality scales. RESULTS: Patients with a history of trauma had higher scores in the delirious and narcissistic items of the Millon Clinical Multiaxial Inventory (MCMI-II) (p < 0.05) and a higher score in the paranoid item of the SCID-5 Personality Disorders Version (SCID-5-PD) (p < 0.05). Patients with distinguishing personality features were grouped according to the Childhood Trauma Questionnaire sexual subscale. Tumor necrosis alpha (TNF-α) showed a significant association with childhood trauma history. CONCLUSIONS: There is a profile of patients with eating disorders who have increased activity in the inflammatory pathways that, if identified precociously, can benefit from specifically aimed interventions. LEVEL OF EVIDENCE: Level V, observational study.

Diseases of renal function and bone metabolism after treatment for early onset cancer: A registry-based study.

Modern cancer therapy has led to a growing number of pediatric and young adult cancer survivors, who are prone to increased morbidities caused by the late effects of therapy. The aim of our study was to investigate pediatric and young adult cancer survivors' morbidity due to renal and bone metabolism diseases and especially to study bone metabolism in cancer survivors with renal disease. Patients were identified from the Finnish Cancer Registry, and the cohort consisted of 13,860, 5-year survivors of cancer diagnosed below the age of 35 years. Healthy siblings were used as the comparison cohort. Information on the main outcomes was linked from the national Care Register for Health Care. Hazard ratios (HRs) comparing cancer survivors to siblings were calculated for various outcomes. The patient cohort was separated into two age groups, pediatric (0-19 years) and young adults (20-34 years). Significantly elevated HRs (p < 0.0001) in survivors were observed in both age groups for scoliosis (HR 1.6, 95% confidence interval [CI] 1.3-2.0), osteoporosis (HR 5.2, 95% CI 2.4-11.4), osteonecrosis (HR 12.7, 95% CI 5.4-29.7), nephritis (HR 1.9, 95% CI 1.5-2.2) and kidney failure (HR 3.6, 95% CI 2.4-5.3) for all. For cancer survivors with a renal outcome, the risk for developing any outcome of bone metabolism was increased (HR 2.3, 95% CI 1.4-3.6). These results show that pediatric and young adult cancer survivors have an elevated risk for long-term, adverse outcomes related to renal function and bone metabolism. These results suggest follow-up care for young cancer patients.

Physical fitness and neurocognitive outcomes in adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime cohort.

BACKGROUND: Survivors of childhood acute lymphoblastic leukemia (ALL) are at increased risk for both treatment-related exercise intolerance and neurocognitive deficits. This analysis aimed to identify the association between exercise intolerance and neurocognitive impairments in ALL survivors. METHODS: Cardiopulmonary exercise testing, results from a 2-hour standardized neuropsychological assessment, and self-report questionnaires were obtained for 341 adult survivors of childhood ALL and 288 controls. Multivariable modeling was used to test associations between oxygen uptake at 85% estimated heart rate (rpkVO2 ) and neuropsychological test and self-reported questionnaire domains, adjusted for sex, age at diagnosis, cranial radiation, anthracycline, and methotrexate exposure and tobacco smoking status. RESULTS: Compared with controls, survivors had worse rpkVO2 and performance on verbal intelligence, focused attention, verbal fluency, working memory, dominant/nondominant motor speed, visual-motor speed, memory span, and reading and math measures (all P < .001). In adjusted models, exercise intolerance was associated with decreases in performance of verbal ability, focused attention, verbal fluency, working memory, dominant motor speed, nondominant motor speed, visual-motor speed, memory span, reading academics, and math academics in survivors. CONCLUSION: This study demonstrates an association between exercise intolerance and neurocognitive outcomes. Research is needed to determine whether interventions that improve exercise tolerance impact neurocognitive function in ALL survivors.

Mental health among nonelderly adult cancer survivors: A national estimate.

BACKGROUND: This study assessed mental health (MH) outcomes across age groups in a nationally representative US sample of adult cancer survivors. METHODS: The 2015 to 2017 National Survey on Drug Use and Health was used to identify respondents aged 18 to 64 years. The authors compared MH outcomes between respondents with a cancer history and respondents without a cancer history in adjusted analyses controlling for demographics and socioeconomic status. Outcomes included past-year major depressive episodes, serious psychological distress, suicidal thoughts, suicidal plans, suicidal attempts, any mental illness, and serious mental illness. All analyses were stratified by age group (18-34, 35-49, or 50-64 years). RESULTS: In a comparison of 2656 survivors and 112,952 individuals without cancer, within each age group, survivors had an elevated prevalence of MH problems in 5 of the 7 outcome measures. Among young adults (aged 18-34 years), survivors were more likely than noncancer counterparts to experience major depressive episodes (18.1% vs 9.6%), serious psychological distress (34.2% vs 17.9%), suicidal thoughts (10.5% vs 7.0%), any mental illness (41.1% vs 23.3%), and serious mental illness (13.2% vs 5.9%) in the past year (P values <.05). These differences persisted in adjusted analyses (P values <.01). Similar survivor-comparison differences were observed among older groups but with a smaller magnitude. Among survivors, young adult survivors had the highest likelihood of experiencing MH problems across all outcomes (P values <.05). CONCLUSIONS: This population-based study shows an elevated prevalence of MH problems among adult cancer survivors in comparison with the general population. This finding highlights the importance of developing strategies to ensure the early detection of mental illness and to improve access to MH treatment for cancer survivors.

Experience of emergency department use among persons with a history of adverse childhood experiences.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with increased morbidity and mortality, lower levels of distress tolerance, and greater emotional dysregulation, as well as with increased healthcare utilization. All these factors may lead to an increased use of emergency department (ED) services. Understanding the experience of ED utilization among a group of ED users with high ACE scores, as well as their experiences as viewed through the lens of a trauma and violence informed care (TVIC) framework, could be important to their provision of care. METHODS: This is the qualitative portion of a larger mixed methods study. Twenty-five ED users with high ACE scores completed in depth interviews. Thematic analysis of the interview transcripts was undertaken and directed content analysis was used to examine the transcripts against a TVIC framework. RESULTS: The majority of participants experienced excellent care although challenges to this experience were faced by many in the areas of registration and triage. Some participants did identify negative experiences of care and stigma when presenting with mental health conditions and pain crises, as did participants who perceived that they were considered "different" (dressed differently, living in poverty, young parents, etc.). Participants were thoughtful about their reasons for seeking ED care including lack of timely access to their family doctor, perceived urgency of their condition, or needs that fell outside the scope of primary care. Participants' experiences mapped onto a TVIC framework such that their needs and experiences could be framed using a TVIC lens. CONCLUSIONS: While the ED care experience was excellent for most participants, even those with a trauma history, there existed a subset of vulnerable patients for whom the principles of TVIC were not met, and for whom implementation of trauma informed care might have a positive impact on the overall experience of care. Recommendations include training around TVIC for ED leadership, staff and physicians, improved access to semi-urgent primary care, ED patient care plans integrating TVIC principles, and improved support for triage nurses and registration personnel.

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS).

OBJECTIVE: To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals. METHODS: The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older. RESULTS: 3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM. CONCLUSION: The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.

Gene-environment interactions between HPA-axis genes and childhood maltreatment in depression: a systematic review.

OBJECTIVE: Gene-environment (GxE) interactions may comprise an important part of the aetiology of depression, and childhood maltreatment (CM), a significant stressor, has consistently been linked to depression. Hence, in this systematic review, we aimed to investigate the interaction between hypothalamus-pituitary-adrenal axis (HPA-axis) genes and CM in depression. METHODS: We conducted a literature search using the Pubmed, Embase, and PsychINFO databases in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies investigating GxE interactions between HPA-axis genes [Angiotensin Converting Enzyme (ACE), Arginine Vasopressin (AVP), Corticotrophin Releasing Hormone (CRH), Corticotrophin Releasing Hormone Receptor 1 (CRHR1), Corticotrophin Releasing Hormone Receptor 2 (CRHR2), FK506 binding protein (FKBP5), Nuclear Receptor subfamily 3 group C member 1 (NR3C1), Nuclear Receptor subfamily 3 group C member 2 (NR3C2)] and CM in depression. RESULTS: The literature search identified 159 potentially relevant studies. Following screening, 138 of these were excluded. Thus, 21 studies, investigating a total of 51 single nucleotide polymorphisms, were included in the final study. The most prevalent genes in the current study were CRHR1 and FKBP5. Significant GxE interactions were reported in seven of eight studies for CRHR1:rs110402 and CM, and in five of eight studies for FKBP5:rs1360780 and CM. In summary, our results suggest possible GxE interactions between CRHR1, FKBP5, NR3C1, and NR3C2 and CM, respectively. For the remaining genes, no relevant literature emerged. CONCLUSIONS: We find that genetic variation in four HPA-axis genes may influence the effects of CM in depression.

Post traumatic stress disorder and coping strategies among adult survivors of earthquake, Nepal.

BACKGROUND: Post traumatic stress disorder (PTSD) is the most frequently reported psychiatric morbidity among the survivors of natural disasters. It is the main hindrance to rehabilitate their life. However its prevalence particularly in Nepal is largely unknown. AIMS AND OBJECTIVES: To investigate the prevalence of post traumatic stress disorder and use of coping strategies among the adult survivors of earthquake. METHODS: A cross- sectional descriptive study was carried out on a sample of 291 adult survivors after 10 months of Nepal Earthquake 2015. Study setting was Nuwakot district with multistage sampling (cluster sampling and systematic random sampling) method. PTSD checklist-5 was used to measure PTSD, and adapted and modified brief cope scale was used to assess coping strategies. Data were analyzed using descriptive and inferential statistics (independent t-test and one-way ANOVA) at 5% level of significance. RESULTS: Study findings revealed that PTSD was prevalent among 24.10% of adult survivors with highest intrusion symptoms (3.24 ± 0.71). It was significantly associated with age (p = 0.017), sex (p = 0.013), education (p < 0.0001) and injury to self (p = 0.003). Elderly, females, illiterates and those who were injured during earthquake are at more risk for PTSD. Highest used coping strategy was active coping (2.92 ± 0.51). Survivors not having PTSD scored more on active coping (p < 0.0001) and self distraction coping (p = 0.006) while those with PTSD mostly used passive coping (p < 0.0001), religious coping (p < 0.0001) and substance use coping (p < 0.0001). CONCLUSION: Earthquake poses significant impact on mental health of the survivors. After 10 months of devastating earthquake, prevalence of PTSD among the survivors is high. Maladaptive coping strategies further increase possibility of PTSD. Effective screening and awareness program regarding promotion of positive coping strategies among the vulnerable groups should be reinforced for prevention of psychiatric morbidity among the survivors of earthquake.

Quality of life in adult survivors after paediatric heart transplantation in Australia.

BACKGROUND: Paediatric heart transplantation in Australia is centralised at The Royal Children's Hospital, Melbourne. Survival to adulthood is improving but the ongoing need for complex medical therapy, surveillance, and potential for late complications continues to impact on quality of life. Quality of life in adults who underwent heart transplantation in childhood in Australia has not been assessed. METHODS: Cross-sectional quality of life data were collected from paediatric heart transplant survivors >18 years of age using Rand 36-Item Health Survey. Self-reported raw scores were transformed to a 0-100 scale with higher scores indicating better quality of life. Mean scores were compared to National Health Survey Short Form-36 Population Norms data using the independent sample t-test. RESULTS: A total of 64 patients (64/151) who underwent transplantation at The Royal Children's Hospital between 1988 and 2016 survived to adulthood. In total 51 patients (51/64, 80%) were alive at the time of the study and 27 (53%) responded with a mean age of 25 ± 6 years, being a median of 11 years (interquartile range 7-19) post-transplantation. Most self-reported quality of life subscale scores were not significantly different from the Australian normative population data. However, self-reported 'General Health' was significantly worse than normative data (p = 0.02). Overall, 93% (25/27) reported their general health as being the same or better compared to 1-year ago. CONCLUSION: Adult survivors after paediatric heart transplantation in Australia report good quality of life in multiple domains and demonstrate independence in activities of daily living and employment. However, lifelong medical treatment may affect perceptions of general health.

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies.

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.

Falling through the cracks. A thematic evaluation of unmet needs of adult survivors of childhood cancers.

OBJECTIVE: The population of adult survivors of childhood cancers (ASCCs) is growing, resulting in unique long-term challenges. This study explored experiences of perceived unmet ASCC survivorship needs. METHODS: We invited ASCCs to complete surveys sent through the cancer registry. Four open-ended questions allowed participants to write in comments. We analyzed responses to these open-ended questions thematically, employing a process of constant comparison. RESULTS: Our sample included 94 ASCCs who completed open-ended questions (61 female; aged 20-78 years, mean age = 34.47, SD = 11.84, mean = 23.27 years post diagnosis). Identified themes included (1) overlooked experiences of distress; (2) lack of counseling: system, patient, and family barriers; (3) difficulty negotiating future life milestones exacerbated by lack of knowledge; and (4) dissatisfaction with service provision: past and present. Prevalent issues identified by participants included lack of supportive care to address needs, distress due to missed developmental milestones as a result of cancer, lack of knowledge about late-term and long-term effects of cancer treatment, and concern over absence of organized long-term follow-up. CONCLUSIONS: Adult survivors of childhood cancers continue to experience unmet needs during their cancer diagnosis, treatment, and long into survivorship due to the treatment for cancer and ongoing side effects. Solutions could focus on addressing the needs of survivors to bridge system gaps and barriers. Specifically, there is a need to improve psychological interventions and transitions from pediatric to adult-care facilities.

Understanding and Improving Knowledge of Cancer Survivorship Care Among College Providers.

This study aimed to assess college providers' basic knowledge of the health risks of young adult cancer survivors (YAS) and related care guidelines and to determine whether an educational in-service is an effective platform for increasing college health providers' knowledge about survivorship care at a large university health center. During phase 1, staff from college health centers and office of disabilities in the Philadelphia area (n = 40 staff members from 24 colleges/universities) completed a needs assessment on their experiences with YAS and preferences for education and care coordination. During phase 2, a 1-h educational in-service, informed by results of the survey, was provided to 18 health center medical providers. While most providers indicated that YAS are at risk for chronic health conditions because of cancer treatment, nearly all were unfamiliar with the content of published long-term follow-up guidelines for cancer survivorship. Over half did not have knowledge of cancer survivorship services in their area. All respondents were interested in more education on cancer survivorship care. Attendees of the in-service increased their knowledge of survivorship follow-up guidelines, awareness of local survivorship resources, and comfort with caring for YAS at posttest relative to baseline. The in-service was highly acceptable to providers and feasible to implement. College providers had little baseline knowledge of cancer survivorship guidelines, but were motivated to obtain more information. Through an educational in-service, college health providers may be better equipped to provide acute and longitudinal survivorship care to a vulnerable population who are at risk for inadequate engagement in risk-based follow-up care.

Attachment insecurity as a mediator of the relationship between childhood trauma and adult dissociation.

This study aimed to investigate whether attachment insecurity mediates the relationship between childhood trauma and adult dissociation, specifically with regard to individual forms of childhood maltreatment. Psychiatric outpatients who visited a specialized trauma clinic (n = 115) participated in the study. Data were collected via the Childhood Trauma Questionnaire, Revised Adult Attachment Scale, and Dissociative Experience Scale. Structural equation modeling and path analysis were performed to analyze the mediating effects of attachment insecurity on the relationship between childhood trauma and adult dissociation. Greater childhood trauma was associated with higher dissociation, and the relationship between them was fully mediated by attachment anxiety. In path analysis of trauma subtypes, the effects of emotional abuse, physical abuse, and physical neglect as a child on adult dissociation were found to be fully mediated by attachment anxiety. The effect of sexual abuse on dissociation was mediated by a synergistic effect from both attachment anxiety and attachment avoidance. Regarding emotional neglect, a countervailing interaction was discovered between the direct and indirect effects thereof on dissociation; the indirect effect of emotional neglect on dissociation was partially mediated by attachment insecurity. Specific aspects of attachment insecurity may help explain the relationships between individual forms of childhood trauma and adult dissociative symptoms. Tailored treatments based on affected areas of attachment insecurity may improve outcomes among patients with dissociative symptoms and a history of childhood trauma.