GENERAL AND SUPPORTIVE CAREPsychosocial issues in adolescents with cancer
Introduction
Cancer in adolescents is uncommon and when it occurs raises a number of unique challenges for both the patient and their families. Adolescence is a period of time of significant physical and emotional changes and a diagnosis of cancer during this time has a major impact on their psychological and physical development. In this review we will look at the psychosocial issues facing adolescents who have cancer. As noted by Whyte and Smith, “for the adolescent with cancer, the problem is often not survival in the future, but survival in the present.”1
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Adolescent development
The emphasis during adolescence is on autonomy, independence and sexuality. Attractiveness plays a key role in self-esteem and self-consciousness is heightened by the range in maturation at any given age. Developmental theorist Erik Erikson points to this phase as one with potential for significant growth and crisis (Table 1). The adolescent is at a fragile point of finding himself at the same time as losing himself while facing multiple physical and social changes.2 Adolescents are also
Autonomy and independence
The diagnosis of cancer places a burden on a teenager’s autonomy and particularly may be difficult to bear as it coincides with the strong developmental pull to separate from parents and to establish an independent identity. This can manifest itself in several ways. Achieving autonomy and independence becomes more complicated as it is difficult to be independent when one needs to have a parent take them to doctors’ appointments or stay at their bedside during their hospitalization. At a time
Informed consent and assent
Treatment of cancer in an adolescent patient can raise complex issues around the role the adolescent plays in the decision-making process. In adults, it is now widely accepted that patients have a right to informed consent before undergoing medical treatment. However, the involvement of pediatric patients in the consent process is less clear and is particularly complicated during adolescence.
In the United States, Britain, and many other countries, adolescents under the age of 18 are viewed as
Initial response to diagnosis
For many, cancer is synonymous with death, and fear is a rational and primal response. Listening and learning guides us as we acknowledge the challenges that face patients with cancer. However, while an empathetic response may be valid for adults, adolescents need a more concrete and proactive response, one that respects their growing autonomy.
Often the adolescent’s response to the diagnosis and the initiation of treatment follows a pattern consistent with the developmental tasks for this age
QOL and the experience of the adolescent with cancer
Quality of life (QOL) during treatment is an important aspect of the care for the adolescent with cancer, but few studies in this area have been done. In one recent study exploring QOL issues for the adolescent with cancer, Wu et al. compared adolescents with cancer on therapy to those off therapy and to healthy controls.11 On therapy, adolescent males and females reported poorer overall QOL and physical functioning. On therapy, females also reported poorer psychological functioning, cognitive
Psychological adjustment
Few studies of psychological adjustment following cancer diagnosis and during treatment have focused specifically on the adolescent population. Studies in broader pediatric oncology populations suggest the majority of these patients do not demonstrate significantly elevated levels of anxiety or depression relative to age-matched controls.18, 19, 20 A significant minority of pediatric oncology patients, estimated to be 17–30%, demonstrate marked psychological distress, including symptoms of
Family
Adolescents with cancer rely on different sources of social support to cope with their diagnosis and treatment. Family, in particular mothers, and peers play a significant role in providing the emotional and social support needed. The supportive role parents (family) play is complicated.32, 33, 34 Adolescents are becoming newly independent and autonomous from their parents yet when diagnosed with cancer they become newly reliant on their parents. Adolescents rely on their family as the most
Conclusion
The psychosocial complexities facing an adolescent with cancer are monumental. When one’s physical and social development is attacked from all fronts it is difficult to grow and maintain normalcy. Health care staff are in a position to recognize the unique psychosocial challenges facing adolescents and facilitate their growth, trust, and hope as they battle cancer.
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