Young Cancer Patients Research Articles

Oncofertility and Fertility Preservation in Cancer Patients Across the Twitterverse.

PurposeInfertility is a major problem affecting children, adolescents, and young adults (AYAs) with cancer, either due to the disease itself or because of oncologic treatment. Oncofertility (OF) focuses on counseling cancer patients about fertility risks and preservation options. However, OF and fertility preservation (FP) conversations on Twitter and their impact are unknown. We aim to characterize the users and type of content of these conversations.Materials and MethodsThis observational study analyzed tweets with the hashtags “#Oncofertility” and “#FertilityPreservation” over eight months. We classified Twitter accounts by user type and country. Tweets were categorized by content type, and retweets and likes were quantified. Descriptive statistics were used for analysis.ResultsA total of 399 tweets from 223 different accounts were evaluated. Twitter accounts comprised 22 countries and stemmed from high, upper-middle, and lower-middle-income countries in 86.5%, 5.4%, and 6.3%, respectively; no accounts from low-income countries were found. Accounts were mostly from physicians (37%) and healthcare centers (20%); we did not find any patient accounts. The most common content category was informative tweets directed to patients (30.8%), followed by discussion/sharing of medical papers (25.6%). Only 14.5% of tweets contained information about children and adolescents. Still, only 4.5% were aimed at children. Retweets were absent in 16.5% of the tweets, and 80.7% did not have comments.ConclusionOF and FP discussions on Twitter were limited to interactions among medical professionals. Also, advocacy groups showed limited activity on social media. Even though a significant proportion of tweets directed to patients were found, no active involvement of patients was observed. Finally, limited number of tweets (4.5%) were directed to children and adolescents. There is a need to raise awareness about the effects of cancer on fertility in this group. Currently, Twitter is not a resource of information for children and AYAs with cancer who need OF counseling and fertility preservation. Our results open a debate on how to promote the use of social media in the future to improve the quality of OF information available, awareness, and care since there is an unmet need for fertility preservation access in young cancer patients.

P-452 Suboptimal quality of integrated female oncofertility care is associated with a lowered quality of life and more decisional conflict and regret in female cancer survivors

Abstract Study question Is quality of female oncofertility care associated with quality of life, decisional conflict, regret, reproductive concerns, and fertility preservation knowledge in female cancer survivors? Summary answer Receiving high-quality integrated female oncofertility care is associated with an improved quality of life, and with less decisional conflict and regret in female cancer survivors. What is known already Female adolescent and young adult cancer patients should be informed about their infertility risks due to cancer treatment. However, adherence to oncofertility guidelines is far from optimal. At this moment, it is not known whether adherence to oncofertility guidelines measured with quality indicators is associated with a better quality of life, less decisional conflict, regret, and reproductive concerns in female cancer survivors Study design, size, duration A multicenter cross-sectional survey study was conducted to measure the association between quality of oncofertility care and patient-reported outcome measures (PROMs). Participants/materials, setting, methods Female AYA cancer survivors (18-40 years) who were diagnosed in 2016 or 2017, and received a (potential) gonadotoxic treatment were eligible to participate. They were recruited from six hospitals across the Netherlands and were asked to fill in a survey. Quality indicators were used to assess quality of care, and validated scales to assess PROMs. Quality indicator and PROM scores were calculated, and associations were analyzed by T-tests and multilevel multivariate analyses Main results and the role of chance In total, 121 out of 344 female cancer survivors participated. Female cancer survivors received a suboptimal quality of care with 8 out of 11 quality indicators scoring <90% adherence. Of all patients, 72,7% was informed about their infertility, 51,2% was offered a referral, with 18,8% all aspects were discussed in counselling, and 35,5% received written and/or digital information. When survivors were informed about infertility risks, and were offered fertility preservation counseling, and received digital/written information (i.e. adherence to three quality indicators), their quality of life was highest, and levels of decisional conflict and regret were lowest. Physical quality of life, decision regret, reproductive concerns, and fertility preservation knowledge scores were significantly influenced by female cancer survivor’s age, relationship status, strength of wish to conceive, and type of cancer. Limitations, reasons for caution Selection bias could have occurred as we have no insight into reasons for non-responding and we have a low response rate. Furthermore, recall bias could have played a role as patients were asked to fill in questions three to four years after their diagnosis, treatment, and consultation. Wider implications of the findings As quality of oncofertility care is suboptimal, strategies should be developed and tailored to the current gaps, and to guideline-specific barriers, to improve quality of care and, importantly, quality of life in female cancer survivors. Trial registration number N/A

Let-7a mimic transfection reduces chemotherapy-induced damage in a mouse ovarian transplantation model

Pharmacological approaches offer a non-invasive and promising option for fertility preservation in young female cancer patients undergoing gonadotoxic therapy. The GnRH-agonists are the only clinically available drugs in this indication, but their use and mechanisms of protection are still controversial. Recently, we have investigated new targeted drugs based on microRNA (miRNA) replacement therapy, and have identified the let-7a miRNA as candidate for fertility preservation strategies. Here, the effect of let-7a replacement during chemotherapy exposure on follicular growth and oocyte maturation capacity was investigated using a mouse ovarian-kidney transplantation model. Newborn mouse ovaries were cultured under different conditions; control, chemotherapy exposure (4-hydroperoxycyclophosphamide, 4-HC), and co-treatment with 4-HC and let-7a mimic transfection (4-HC + let-7a). The ovaries were then transplanted under the kidney capsule of recipient mice and follicular growth, survival, and oocyte in vitro maturation were assessed after 3 weeks. The results showed that the follicular pool was highest in the control group but higher in the 4-HC + let-7a group than the 4-HC group. DNA-damage/apoptosis ratios were higher in all 4-HC-exposed groups compared to control but were reduced in the 4-HC + let-7a group. In addition, the post-transplantation oocyte in vitro maturation rate was higher in the 4-HC + let-7a group compared to the 4-HC group, suggesting better oocyte quality. These results provide new information regarding the beneficial effects of let-7a replacement against chemotherapy-induced ovarian damage and open new perspectives for future in vivo applications.

Adolescent and Young Adult Cancer Patients’ Supportive Care Needs—A Social Work Perspective

Abstract The purpose of this study was to identify (unmet) needs from a social work perspective of Adolescents and Young Adults (AYAs; aged eighteen to thirty-nine years) treated for cancer. The biopsychosocial model was used as framework to investigate the (unmet) needs of the AYAs. AYAs within two years after their cancer diagnosis were invited to participate in an interview. In addition, case studies were presented. Nine AYAs agreed to participate in the interviews. All respondents struggled with the rehabilitation and ‘post cancer’ phase and the impact of the treatment on their physical, sexual and psychological well-being. AYAs with an active desire to have children mentioned lack of information about the options of fertility preservation. The respondents would recommend psychosocial support for their peer AYAs, despite the absence of a need themselves. Themes such as lack of control, social economic (financial) status and existential issues were less prominent. Social workers should standardly be involved in the hospitals’ care path throughout the disease continuum: starting at diagnosis, continuing throughout treatment, and importantly, also in the rehabilitation phase and end-of-life care. The biopsychosocial model can serve as a tool to support the social worker in the counselling of these AYAs.

Effects of Chemotherapy on Fertility Preservation in Patients with Tumors of the Hematopoietic and Lymphoid Tissues

Fertility preservation is an important concern for young cancer patients. Oocyte or embryo cryopreservation prior to chemotherapy administration is desirable but often difficult for patients with hematopoietic and lymphoid tissue tumors. In this study, we examined the results of fertility preservation therapy in patients with hematopoietic and lymphoid tissue tumors. We retrospectively examined hematopoietic and lymphoid tissue tumors of five patients who underwent oocyte cryopreservation as a fertility preservation therapy after chemotherapy, at Showa University Hospital from February 2017 to September 2020. Eleven treatment cycles were administered (one of which was cancelled). The mean age of the patients was 28.6 years. The mean controlled ovarian stimulation duration for 10 cycles was 15.9 days, the mean total gonadotropin dose was 3705 IU, and the mean peak E2 was 502.8 (pg/mL). The mean number of eggs retrieved was 3.2, the mean number of mature oocytes was 2.1, and the mean maturation rate (mature oocytes/returned oocytes) was 70.7%. Fertility preservation procedures in the early period after chemotherapy may be viable because they allow for the acquisition of mature oocytes, even though the procedures may take longer and yield fewer oocytes.

Standardization of Fertility Preservation Discussion Among Pediatric Oncology and Bone Marrow Transplant Patients: A Single Institution Experience.

Purpose: Infertility is an impactful late effect of cancer therapy. Options for fertility preservation exist, however, barriers remain. Within our division, we lacked a standard approach to discussing fertility preservation. Methods: During the time period of 2014-2020, a fertility preservation program was developed with program improvements implemented over time and provider comfort with fertility identified and addressed through educational intervention. To evaluate how our improvements affected frequency of documented reproductive health discussions, 474 pubertal pediatric patients with new oncological diagnoses were reviewed. Descriptive analysis of sociodemographic determinants was performed. Results: One hundred seventy-five patients met inclusion criteria. Racial/ethnic composition was similar in those receiving and not receiving a fertility consult. Although 19.3% of Caucasians pursued fertility preservation, none of the eight African Americans or five Hispanic females did. Division feedback identified a lack of knowledge regarding available fertility preservation options and diagnoses that should prompt this conversation as barriers to the consulting fertility preservation team. Pre- and posteducation assessments demonstrated increased comfort in discussing fertility preservation and knowledge regarding diagnoses at higher risk of infertility. Integration of a standardized fertility preservation process and addressing barriers identified led to a 33.6% increase in fertility discussions. Conclusion: The establishment of a fertility preservation process and team and division-wide education has led to improvement in rates of fertility discussion in pediatric and adolescent and young adult cancer patients. Similar to young adult data, our data suggest that some racial health disparities may exist in the utilization of fertility preservation in the pediatric oncology population.

Sexual dysfunction among adolescent and young adult cancer patients: diagnostic and therapeutic approach.

We present a review for healthcare professionals, formulated by a multidisciplinary team, for screening and interventions, describing common sexual impairments encountered by adolescent and young adult cancer patients (AYACP), and suggest a comprehensive evidence-based assessment approach and interventions for treatment of sexual dysfunction (SD). We discuss the various aspects of SD in AYACP, including causes, challenges and etiologies, and then go on to recommend increased awareness and guidance in healthcare workers, in order to optimize diagnosis and treatment of SD. Although the extent of SD among AYACP is widely recognized, oncological clinicians rarely address SD in their routine practice, lacking a clear approach of interdisciplinary diagnostic and therapeutic interventions. Here, we suggest guiding clinical management to optimize treatment quality.

Support and Challenges for Adolescent and Young Adult Cancer Patients

The current adolescent and young adult (AYA) generation represents a unique age group, among whom life changes dramatically due to living environments including school, seeking employment, marriage, and pregnancy, and due to lack of a social support system for cancer during the AYA years. The 3rd term of the Basic Plan for Cancer Control Promotion has stimulated increased momentum toward medical community involvement with AYA generation cancer patients, leading to the establishment of a Department of Cancer in the AYA Generation at our hospital. While promoting provision of highest quality team-based medical care, we have also been working to provide the best daily life/social life support, using our abundance of treatment experience, and taking into consideration various problems peculiar to AYA individuals, including anxiety about the future, a desire to preserve fertility, and a need for reproductive support. Pharmacists are involved in pharmacotherapy as part of medical treatments for AYA patients, aiming to provide optimal pharmacotherapy based on the practice of accurate pharmaceutical management. We foster collaborations between various clinical departments to tackle AYA-specific issues including preservation of fertility. Future challenges to address include long-term follow-up on such issues as late-stage disorders and endocrine disorders after AYA patient cancer treatment. Under current circumstances, our time for face-to-face interaction with patients as members of the hospital's medical staff is limited. Currently, we are involved in the operation of a breast cancer salon that aims to improve breast cancer patients' quality of life by supporting these patients during diagnosis and treatment.

A cross sectional survey to assess knowledge, attitude, and practice of Yoga among cancer patients at a tertiary care hospital in Rishikesh, India.

e24040 Background: The global cancer burden continues to rise, putting individuals under severe physical, mental, and financial stress. Yoga may aid chemotherapy patients to improve their quality of life. The purpose of this survey is to learn more about the gaps in knowledge, attitude, and practice of Yoga and barriers. Methods: The cross-sectional time-bound survey was conducted on cancer patients of age 18 years and above receiving cancer treatment at the outpatient clinic of AIIMS Rishikesh. We collected data of 738 cancer patients, bivariate and multivariate analysis was done to understand the level of awareness of the importance of Yoga as an alternative therapy. Results: Of 738 cancer patients who participated, 90.2% had heard about Yoga. Among those aware of yogic practices, only 15.9% knew that Yoga is an alternative therapy across the world. Knowledge of yogic importance was associated with age (OR = 1.16, 95% CI = 1.07-1.26, p = 0.002), education (OR = 0.5, 95%CI = 0.4-0.6, p < < .001), religion (OR = 1.16, 95%CI = 1.1-1.2, p < < .001). Attitude towards Yoga with the belief that it helps maintain mental health has a positive association with education (OR = 0.9, 95% CI = 0.8-0.9, p = 0.03). Almost 56% of cancer patients had never practiced Yoga. The identified barriers in yogic kriya practice were lack of time, interest, and facilities. Conclusions: The knowledge of the benefits of Yoga on health was high in adolescent young cancer patients. Still, the motivation towards yoga practice is limited due to various factors like lack of infrastructure, time, belief. The gap between knowledge, attitude, practice, and barriers can be overcome by conducting effective yogic programs for this population.

Risk Factors and Challenging Management of Lung Adenocarcinoma in Young Adult Women: Case Series

Introduction: Lung cancer found in young age is relatively rare with a percentage of cases only 1.4% of overall lung cancer cases in the world. Case: We reported two cases of lung adenocarcinoma in young women aged less than 30. The first case was lung adenosquamous carcinoma in a 28-year-old woman, a passive smoker, who had a family history of cancer. She had the mutation of epidermal growth factor receptor (EGFR) exon 19 deletion and received 1st generation of tyrosine kinase inhibitor. Since the patient was diagnosed at advanced stage with poor performance status, she died within 2 months after being diagnosed. The second case was lung adenocarcinoma in a 23-year-old woman. The patient was a passive smoker and had a history of cancer in the family. She was diagnosed at an advanced stage but with good performance status. The patient underwent chemotherapy with Pemetrexed-Platinum in 6 cycles and 15 cycles of radiotherapy. Conclusion: Lung cancer at a young age is more common in non-smoking female with the histopathology type adenocarcinoma. Non-specific early symptoms become a problem in the early enforcement of lung cancer at a young age. Many cancer-related issues occur in young cancer patient such as premature death, increased dependence on parents, difficulty in school and work due to medication, and reproductive disturbance.

A Multicomponent Telehealth Intervention to Improve Oncofertility Care Delivery Among Young Cancer Patients: A Pilot Study.

Purpose: Oncofertility care for pediatric, adolescent, and young adult cancer patients remains under-implemented across adult and pediatric oncology settings. We pilot tested an electronic health record (EHR)-enabled multicomponent oncofertility intervention (including screening, referral, and fertility consult) in an adult academic oncology program and systematically assessed intervention fit to pediatric and community oncology programs. Methods: Using surveys (n = 33), audits (n = 143), and interviews (n = 21) guided by implementation science frameworks, we pilot tested the EHR-enabled intervention for oncofertility care in young cancer patients at an adult oncology program and evaluated implementation outcomes. We interviewed health care providers from seven regional oncology and fertility programs about intervention fit to their clinical contexts. Results: We recruited 33 health care providers from an adult oncology setting and 15 health care providers from seven additional oncology and fertility settings. At the adult oncology setting, the intervention was found to be appropriate, acceptable, and feasible and improved the screening of fertility needs (from 30% pre- to 51% post-intervention); yet, some patients did not receive appropriate referrals to fertility consults. Providers across all settings suggested content and context modifications, such as adding options to the intervention or allowing the screening component to pop up at a second visit, to improve and adapt the intervention to better fit their clinical care contexts. Conclusions: We found that the EHR-enabled intervention increased the rate of goal-concordant oncofertility care delivery at an adult oncology program. We also identified facilitators, barriers, and needed adaptations to the intervention required for implementation and scaling-up across diverse oncology settings.

Factors Affecting Hospice Use Among Adolescents and Young Adult Cancer Patients.

Background/Objective: Compared to existing studies on end-of-life care of mid- to older-aged patients diagnosed with cancer, there is a paucity of research on adolescents and young adult (AYA) patients. Guided by the Anderson's Behavioral Model for Healthcare Utilization, this study examined predisposing/enabling/need factors associated with hospice referral/enrollment among AYA patients diagnosed with cancer. Methods: Data were drawn from medical records of AYA patients who died of cancer between January 2013 and December 2016 at three academic sites in the United States and were 15-39 years old at the time of death. Logistic regression was conducted (N = 224). Results: Findings showed that hospice referral was strongly associated with hospice enrollment (odds ratio [OR] = 69.68, p < 0.0001). White patients were more likely to be referred to hospice care than non-White patients; the effect was, however, significant only among patients with private insurance (OR = 3.44, p = 0.040). Patients with public insurance were more likely to be referred to hospice than those with private insurance; the effect was, however, significant only among non-White patients (OR = 5.66, p = 0.005). Among those not receiving cancer treatment in the last month of life (LML), patients with hematologic malignancies were less likely to be referred to hospice than those with solid tumors (OR = 0.19). Among patients with solid tumors, receiving cancer treatment in the LML lowered the odds of hospice referral (OR = 0.50, p = 0.043). Conclusion: Further research efforts are needed to investigate the role of race, insurance, cancer types, and treatments in hospice use among bigger samples of AYA patients diagnosed with cancer.

The Clinical Utility of the Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST): Perspectives of AYA Cancer Patients and Healthcare Professionals.

ObjectiveRoutine psychosocial screening and assessment of people diagnosed with cancer are crucial to the timely detection of distress and provision of tailored supportive care; however, appropriate screening tools have been lacking for adolescents and young adults (AYAs), who have unique needs and experiences. One exception is the recently validated AYA Psycho-Oncology Screening Tool (AYA-POST) for use with young people aged 15–29 years, which comprises a distress thermometer and age-specific needs assessment. This study investigates the clinical utility of this measure, as well as the subsequent service responsiveness within the Australian Youth Cancer Services.MethodIn total, 118 AYAs and 29 healthcare professionals: (HCPs) completed surveys about the clinical utility of the AYA-POST; a subset of 30 AYAs completed a 3-month follow-up survey assessing service responsiveness. Descriptive statistics (frequencies/means) were computed for all items, with chi-square analyses used to explore whether perceived clinical utility varied with AYA age, AYA sex, HCP discipline or HCP length of time using the AYA-POST.ResultsParticipants’ responses demonstrate high levels of satisfaction with the tool, evidencing its appropriateness, practicability and acceptability. Moreover, the AYA-POST was reported to facilitate communication about psychosocial needs and prompt referrals, indicating good service responsiveness. Ratings of clinical utility did not differ significantly between AYA and HCP groups.ConclusionThis study demonstrates that the AYA-POST is an appropriate tool in the psychosocial screening of AYAs with cancer, facilitating the identification of distress and unique concerns in this population and valuable in triaging and tailoring care for young cancer patients.

Young-onset colorectal cancer: Insights from an English population-based study.

Young colorectal cancer (CRC) patients are reported to have more aggressive disease, an advanced stage at diagnosis and conflicting survival outcomes. The aim of this study was to analyse the demographics, clinicopathological features and prognosis of young CRC at a population-based level in England. This is a retrospective review of all CRC patients using data from Public Health England collated from regional cancer registries in England between 2010 and 2014. Those aged 40 years and below were classified as young and those over 40 were classified as older. Overall, 167,501 patients had CRC. Of these, 3757 patients (2.2%) were young. Right-sided cancers were more common in younger patients (48.2% vs. 32.9%, p< 0.001). Favourable histological grade (well or moderately differentiated) was present in 83.1% and 73.5% of young and older patients, respectively. The percentage of young and older patients being diagnosed at an early stage (Stages 1 and 2) was similar at 40.6% vs. 42.9%. The 5-year age- and gender-adjusted relative survival (cancer specific) was significantly better for young patients when compared with older patients diagnosed with CRC. Additionally, overall 5-year survival was better for younger patients (71.6% and 47.2%, p< 0.001 in young and older CRC patients respectively). The increased right-sided colon cancer in young CRC patients in England warrants attention. Contrary to previous reports, they do not present at later stage. Young CRC patients have better overall and relative survival than older patients with CRC.

PD16-12 AGE AND RACE SPECIFIC GENE SIGNATURE: AN INDEPENDENT PREDICTOR OF PROSTATE CANCER IN RACIALLY DIVERSE MILITARY COHORT OF AFRICAN AND CAUCASIAN AMERICAN PATIENTS

You have accessJournal of UrologyCME1 May 2022PD16-12 AGE AND RACE SPECIFIC GENE SIGNATURE: AN INDEPENDENT PREDICTOR OF PROSTATE CANCER IN RACIALLY DIVERSE MILITARY COHORT OF AFRICAN AND CAUCASIAN AMERICAN PATIENTS Shashwat Sharad, Darryl Nousome, Gregory Chesnut, and Hua Li Shashwat SharadShashwat Sharad More articles by this author , Darryl NousomeDarryl Nousome More articles by this author , Gregory ChesnutGregory Chesnut More articles by this author , and Hua LiHua Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002548.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Age and Racial disparities in prostate cancer (PCa) is a serious challenge and the PCa mortality rates are nearly three times higher in African American (AA) men younger than age 65 than White Caucasian American (CA) men. Young age prostate cancer is more likely to be an aggressive cancer commonly seen in AA population. The objective of this study is to examine the age and racial disparities associated gene signatures for disease progression, patient stratification and targeted therapeutic options. METHODS: Specimens collected from radical prostatectomy patients (41 CA and 20 AA) who provided written consent under protocols (#393738, #GT90CM/385525 and #908925) approved by the Institutional Review Boards of the Walter Reed National Military Medical Center (WRNMMC) and the Uniformed Services University of the Health Sciences (USUHS). We used a cohort of non-familial PCa patients of AA and CA origin. Total RNA was extracted from tumor, and adjacent normal epithelium of formalin-fixed-paraffin-embedded (FFPE) specimens by Laser capture microdissection (LCM). Differential gene expression in tumor versus normal tissues between young and old AA and CA patients were analyzed by NanoString using a customized CodeSet of 151 probes sets. The panel was designed to detect 135 target transcripts, which were compiled from 34 genes implicated in or associated with prostate cancer progression, 27 prostate cancer specific gene fusions, 25 cancer associated genes, five genes encoding the ETS-family of transcription factors and genes over-expressed (27) or under-expressed (17) in PCa compared to matched benign epithelium. In addition, five prostate stroma or epithelium specific genes were selected as control and 11 housekeeping genes were included for biological normalization. RESULTS: The differentially expressed genes related to tumor-normal differences between the old (66–73 yrs) and young (42–58 yrs) AA and CA prostate cancer patients with Gleason (3+3 and 3+4) were identified. After controlling for false discovery rates, we identified a panel of nine genes (ANXA2, C-MYC, VEGFR1, ERG, NPY, PSMA/FOLH1, TWIST1, MAOA, MYCN) uniquely associated with the age and race. The tumor vs. normal ratios of ANXA2 and c-MYC expression in prostate tumors of old and young patients were found to be significant. We found a clear association of VEGFR1 gene expression with CA young and c-MYC gene with AA young PCa. Our study highlights the potential of using FFPE tissue as a source for the analysis of prognostic biomarkers for PCa. CONCLUSIONS: An unmet challenge in PCa is the identification of biomarkers for early detection of aggressive disease. Effective biomarkers with high specificity will provide early treatment options for high-risk patients. Using Age and Race as the endpoint, we identified ANXA2, c-MYC and VEGFR1 as age and race associated PCa gene which needs to be further validated in the lager cohort. Our findings clearly highlight distinct racial and age-related differences and addresses the clinical utility of available genetic tests across old and young AA and CA men. Source of Funding: This study was supported by CPDR, USUHS, HU0001-10-2-0002 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e273 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shashwat Sharad More articles by this author Darryl Nousome More articles by this author Gregory Chesnut More articles by this author Hua Li More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect Evaluation of Mental Nursing in Nursing of Young Cancer Patients Based on Big Data.

The field of mental health nursing has always been special, dynamic, and flexible in terms of enhancing individuals' quality of life. Mental health nursing is all about caring for individuals with mental health disorders with the aim of helping them recover from illness, thereby improving their living conditions. Health Education of mental nursing emphasizes on providing special care to patients and optimally fulfills the clinical outcomes of the patients. It has been widely accepted that mental illness negatively influences the well-being of individuals, irrespective of their age, origin, demography, social status, and economic status. Young patients diagnosed with cancer report that they have a poor quality of life, as they undergo several physical and psychological needs, especially after the surgery and other cancer-related treatments. Thus, this study aims to examine the effect of mental health nursing on nursing young patients with cancer, based on the big data. Thus, the study conducts longitudinal analysis of the data gathered from the young patients with cancer, monitored by mental health nurse, with advanced practice nurse (APN) interventions. Results of the study stated that APN interventions positively impacted the physical as well as psychological needs of the research subjects. Mental nursing interventions resulted in positive clinical outcomes of the patients.

Tertiary experience of managing young bladder cancer patients

Objective: Bladder cancer is rare in young patients and some authors have concluded that this group have a favourable outcome. We aimed to analyse our experience with such patients. Patients and Methods: Patients aged 50 years or younger were identified via a retrospective review of pathology samples between 2016 and 2020. Data regarding demographics, symptoms, stage, grade, size and multifocality at initial transurethral resection, recurrence rate and progression were analysed. Results: 60 patients with an average age of 42 were identified. The majority of patients presented with intermediate-risk non-muscle invasive bladder cancer (NMIBC). Four patients presented with muscle invasive and three with metastatic disease. There were seven deaths. Forty-nine patients with NMIBC were followed-up for an average of 5 years and 2 months. 41% of our cohort did not have a recurrence and only four moved up the risk stratification. No patients under 40 presented with muscle invasive disease and the majority had intermediate risk NMIBC. Conclusion: Young patients typically present with intermediate-risk NMIBC which rarely progresses. Very high-risk disease and aggressive variants do occur and may benefit from upfront cystectomy. The rate of muscle-invasive disease increases with age and rarely occurs under 40. Until more data is readily available, the management of this cohort of patients should follow the well-established guidelines. Level of evidence: 4 (case series)

Hormone Therapy Use Among Young Patients with Cervical Cancer in Southern Saskatchewan

ObjectiveTreatment for cervical cancer can cause cessation of ovarian function in young patients. Physician counselling practices related to premature menopause and hormonal therapy (HT) for young cervical cancer patients is not well known. The primary objective of this study was to assess the frequency of HT counselling and usage among young cervical cancer patients. The secondary objective was to assess clinical and demographic factors associated with HT use. MethodsThis retrospective review included adult women younger than age 50 years who received treatment for cervical cancer between 2007 and 2017. Patient and disease characteristics, disease outcome, and documentation of HT and bone health counselling were collected from electronic records. Descriptive statistical analysis was performed for the primary objective, and independent t tests and χ2 tests were used for secondary objective data analysis. ResultsIn this study, 67 premenopausal women with cervical cancer (stages I–III) lost ovarian function from cancer treatment, of whom 52% had received counselling on HT from their oncologists. Thirty-nine percent of patients were using HT at the time of their last review. Younger women were more likely than older women to receive HT counselling (mean age 37.3 ± 6.6 y vs. 42.4 ± 6.0 y; P = 0.001). Counselling frequency and usage of HT were not affected by cancer stage, body mass index, or smoking status. ConclusionYoung asymptomatic patients should receive HT if not contraindicated, yet half of qualified cervical cancer patients in this study received counselling on premature menopause and HT. Structured counselling on HT should be implemented as an integral part of cervical cancer care.

Fear of Recurrence in Young Adult Cancer Patients—A Network Analysis

Simple SummaryFear of cancer recurrence is a main concern for the majority of cancer patients during their disease. Young adults with cancer may experience fear of recurrence throughout their lives, given their relatively long potential survival time. More research is needed to identify evidence-based interventions that can adequately address this fear. Investigating the underlying mechanisms that trigger and sustain fear of cancer recurrence is an important step toward this goal. Network analysis is a useful tool to study symptoms and their structural relationships. The aim of this study is to apply the network analysis approach in a sample of young cancer patients to comprehend their specific symptomatology and define the optimal structure of a questionnaire to assess fear of recurrence in this patient group. Future studies may seek to replicate our findings among different age group samples to identify network structures and potential targets for clinical intervention.Due to the high survival rates of many young cancer patients and a high risk of second tumors, fear of cancer recurrence (FCR) can cause serious impairment for adolescent and young adult (AYA) cancer patients. The aim of this study is to analyze the structure of the Fear of Disease Progression Questionnaire (FoP-Q-12) to better understand the construct of FCR. We performed a cross-sectional survey on a sample of AYA patients aged 15–39 years with different tumor entities. FCR was measured using the FoP-Q-12, and a network analysis was conducted to examine the relationship of FCR symptoms. The importance of individual items in the network was determined using centrality analyses. A total of 247 AYA patients (81.8% female, median age 31.0 years) participated in the study. The mean FCR score in the sample was 35.9 (SD = 9.9). The majority of patients reported having high FCR (59.5%), according to the established cut-off. The two questionnaire items with the strongest association related to fears about work, and the most central symptom was the fear of serious medical interventions. The centrality of emotional issues in the sample indicates that these symptoms should be prioritized in the development of interventions targeting FCR. Further research should address this topic with larger samples of patients in other age groups and in longitudinal studies.

Factors impacting adolescent and young adult cancer patients' decision to pursue genetic counseling and testing.

Adolescent and young adult (AYA) cancer patients face challenges when navigating cancer treatment and survivorship. Many are at risk for cancer predisposition syndromes; however, factors influencing pursuit of genetic counseling and testing have not been reported. We describe AYA cancer patients' decision-making process, including motivational factors and barriers, as it relates to utilization of genetic services. Thirty AYAs diagnosed with cancer previously referred for cancer predisposition genetic counseling completed semi-structured interviews via audio-only Zoom calls. Thematic analysis was used to perform qualitative analysis and identify major themes. The sample comprised 21 AYAs who had genetic counseling and nine who did not. Motivational factors identified included learning genetic counseling is an available service, concern about the impact of a hereditary syndrome on family members and family planning, learning about the need for cancer screening or prevention, affordability of genetic testing, and easing worry about additional cancer risks. For those who did not pursue genetic counseling, barriers included scheduling or other priorities, worry, and cost. However, the majority expressed they would reconsider genetic counseling in the future. AYA cancer patients have similar motivational factors to pursue genetic counseling compared to other patients; however, their younger age of diagnosis may alter how these factors affect decision-making. While there are barriers limiting access to genetic services, they did not decrease interest in future genetic counseling for most patients. Genetic counseling and testing should be discussed with patients who previously declined genetic services.