Elsevier

Cancer Treatment Reviews

Volume 33, Issue 7, November 2007, Pages 622-630
Cancer Treatment Reviews

GENERAL AND SUPPORTIVE CARE
Psychosocial issues in adolescents with cancer

https://doi.org/10.1016/j.ctrv.2006.12.006Get rights and content

Summary

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. We will address adolescent development, issues related to informed consent and assent, initial responses to the diagnosis of cancer, quality of life and the experience of the adolescent with cancer, psychological adjustment, support systems, body image issues, sexuality, education, hope, and treatment compliance.

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

Section snippets

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.

References (87)

  • J. Piaget

    The origins of intelligence in children

    (1952)
  • H. Hokkanen et al.

    Adolescents with cancer – experience of life and how it could be made easier

    Cancer Nurs

    (2004)
  • J.J. Spinetta et al.

    Refusal, non-compliance, and abandonment of treatment in children and adolescents with cancer: A report of the SIOP working committee on psychosocial issues in pediatric oncology

    Med Pediatr Oncol

    (2002)
  • J.L. Lee et al.

    Assent for treatment: clinician knowledge, attitudes, and practice

    Pediatrics

    (2006)
  • American Academy of Pediatrics, Committee on Bioethics. Informed consent, parental permission, and assent in pediatric...
  • H. Kyngas et al.

    Coping with the onset of cancer: coping strategies and resources of young people with cancer

    Eur J Cancer Care

    (2001)
  • M. Hedstrom et al.

    Perceptions of distress among adolescents recently diagnosed with cancer

    J Pediat Hematol Oncol

    (2005)
  • M. Hedstrom et al.

    Accuracy of assessment of distress, anxiety, an depression by physicians and nurses in adolescents recently diagnosed with cancer

    Pediat Blood Cancer

    (2006)
  • E. Wu et al.

    Assessment of health-related quality of life of adolescent cancer patients using the minneapolis-manchester quality of life adolescent questionnaire

    Pediat Blood Cancer

    (2006)
  • S. Shankar et al.

    Health-related quality of life in young survivors of childhood cancer using the minneapolis-manchester quality of life-youth form

    Pediatrics

    (2005)
  • W.A. Bleyer

    Cancer in the older adoelscents and young adults: epidemiology, diagnosis, treatment, survival, and importance of clinical trials

    Med Pediat Oncol

    (2002)
  • I.J. Lewis et al.

    Cancer and the adolescent: the second teenage cancer trust international conference, royal college of physicians, London, England, march 2001

    Med Pediatr Oncol

    (2002)
  • A. Mulhall et al.

    A qualitative evaluation of an adolescent cancer unit

    Eur J Cancer Care

    (2004)
  • B.C. Reynolds et al.

    A comparison of self-reported satisfaction between adolescents treated in a “teenage” unit with those treated in adult or paediatric units

    Pediat Blood Cancer

    (2005)
  • L. Goertzel et al.

    Health locus of control, self-concept, and anxiety in pediatric cancer patients

    Psychol Rep

    (1991)
  • A.L. Pai et al.

    A meta-analysis of the effects of psychological interventions in pediatric oncology on outcomes of psychological distress and adjustment

    J Pediatr Psychol

    (2006)
  • A.F. Patenaude et al.

    Psychosocial functioning in pediatric cancer

    J Pediatr Psychol

    (2005)
  • J. Kashani et al.

    Depression in children and adolescents with malignancy

    Can J Psychiatry

    (1982)
  • M.S. Sanger et al.

    Psychosocial adjustment among pediatric cancer patients: a multidimensional assessment

    J Pediatr Psychol

    (1991)
  • N.C. Frank et al.

    Attributions, coping, and adjustment in children with cancer

    J Pediatr Psychol

    (1997)
  • R.K. Mulhern et al.

    Maternal depression, assessment methods, and physical symptoms affect estimates of depressive symptomology among children with cancer

    J Pediatr Psychol

    (1992)
  • R.W. Butler et al.

    Neurocognitive interventions for children and adolescents surviving cancer

    J Pediatr Psychol

    (2005)
  • B.J. Zebrack et al.

    Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study

    J Clin Oncol

    (2004)
  • M. Pao et al.

    Psychotropic medication use in pediatric patients with cancer

    Arch Pediatr Adolesc Med

    (2006)
  • L.S. Kersun et al.

    Prescribing practices of selective serotonin re-uptake inhibitors (SSRIs) among pediatric oncologists: a single institution study

    Pediatr Blood Cancer

    (2006)
  • R.L. Woodgate

    The importance of being there: perspectives of social support by adolescents with cancer

    J Pediat Oncol Nurs

    (2006)
  • H.B. Haluska et al.

    Sources of social support: adolescents with cancer

    Oncol Nurs Forum

    (2002)
  • I.B. Ressler et al.

    Continued parental attendance at a clinic for adult survivors of childhood cancer

    J Pediat Hematol Oncol

    (2003)
  • A. Ishibashi

    The needs of children and adolescents with cancer for information and social support

    Cancer Nurs

    (2001)
  • S. Manne et al.

    Social support, social conflict, and adjustment among adolescents with cancer

    J Pediat Psychol

    (1998)
  • S.S. Larouche et al.

    Changes in body image experienced by adolescents with cancer

    J Pediat Oncol Nurs

    (2006)
  • R.L. Woodgate

    A different way of being: adolescent’s experiences with cancer

    Cancer Nurs

    (2005)
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