Psychological Outcomes and Health Beliefs in Adolescent and Young Adult Survivors of Childhood Cancer and Controls

Abstract

A B S T R A C T PurposeThe purpose of this study was to compare adolescent and young adult (AYA) pediatric cancer survivors and peers without a history of serious illness on psychological distress, health-related quality of life (HRQOL), health beliefs; examine age at diagnosis and cancer treatment intensity on these outcomes; and examine relationships between number of health problems and the outcomes. Patients and MethodsAYA cancer survivors (n ϭ 167) and controls (n ϭ 170), recruited during visits to a cancer survivorship clinic and primary care, completed self-report questionnaires of distress, health problems, and health beliefs. For survivors, providers rated treatment intensity and health problems. ResultsThere were no statistically significant differences between survivors and controls in psychological distress or HRQOL. Cancer survivors had less positive health beliefs. Survivors diagnosed as adolescents had significantly greater psychological distress and fewer positive health beliefs than those diagnosed earlier. Survivors with the highest level of treatment intensity had greater anxiety and fewer positive health beliefs than those with less intense treatments. Provider report of current health problems related to survivors' beliefs and mental HRQOL only, whereas patient report of health problems correlated significantly with most psychosocial outcomes and beliefs. ConclusionAYA cancer survivors did not differ from peers in psychological adjustment but did endorse less adaptive health beliefs. Survivors diagnosed during adolescence and who had more intensive cancer treatments evidenced poorer psychosocial outcomes. Beliefs about health may be identified and targeted for intervention to improve quality of life, particularly when patient perceptions of current health problems are considered.

Quality of life in children with retinoblastoma after enucleation in China

“…Some evidence has indicated that older diagnosis ages of pediatric patients with cancer are associated with more physiological and psychological problems in long-term cancer survivors. 20 The Indian study of children with RB reported that when the diagnosis age was younger (≤18 months), the scores on the school and social dimensions for the pediatric patients with RB were higher. It is thought that when pediatric patients receive surgery and treatment at younger ages, they have fewer memories and experiences of the corresponding pain and higher acceptance of the ocular prosthesis; therefore, the influences on the appearance of pediatric patients were lower, and the quality of life was also relatively high.…”

Promoting Resilience among Parents and Caregivers of Children with Cancer

“…18,36 Evolving personal states (coping skills, spirituality, hope), 16,33 social support, 36 family cohesion, spousal communication, and changes in socioeconomic status 37 were all associated with caregiver resilience, as were modifiable aspects of the medical experience (caregiver perceptions of the experience and associated stressors). 5,[38][39][40][41] Parents with better insight into their child's prognosis were better able to set realistic goals 42,43 or prepare for their child's death; 43,44 such abilities may encourage more positive psychosocial outcomes. 11,[42][43][44][45] Finally, much of the clinical literature related resilience to positive psychosocial outcomes, a lack of adverse outcomes (comparative normalcy), or those patients and families who go on to lead psychologically healthy or productive lives.…”

“…1 Recent literature has called for the integration of psychosocial care into standard medical oncology practice, 2,3 including routine screening for psychological distress and identification of those in need of additional support. 4 As with studies conducted among adult cancer patients, pediatric studies have generally focused on negative psychosocial outcomes among cancer survivors 5 and family members. 6 Parent mental health can influence family function as well as affect patient and sibling quality of life and physical health [7][8][9] ; hence, efforts to reduce parent distress are critical.…”

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…200 The need for information, counseling, and practical support was reported in 57%, 41%, and 39% of AYA patients, respectively, at 12 months after the diagnosis of cancer. 197 Kazak et al 201 reported that intensive cancer treatments during adolescence are associated with inferior psychosocial outcomes and health beliefs in survivors compared with their age-matched peers. Psychological problems are also associated with an increased risk for obesity and poor health behavior, which may increase future risk for chronic health conditions and secondary neoplasms.…”