Symptom interval in young people with bone cancer

Symptom interval (SI), the time from first symptom/sign to diagnosis and initiation of treatment, appears to be principally influenced by tumour biology. Whether the age of the patient, patient delay, professional delay and access to health professionals influences the SI in bone tumours was investigated in this study. 115 patients with newly diagnosed osteosarcoma and Ewing's sarcoma were retrospectively reviewed. The median total SI for all bone tumours was 3.8 months (range 1-46 months). Patients older than 12 years had a longer SI (P = 0.05) and more patient delays (P = 0.02). Total SI and professional delays were longer if the General Practitioner was first seen compared with an Accident and Emergency Consultant (P = 0.02 and 0.02, respectively). However, SI did not influence overall and event-free survival in this series. Bone tumour patients have long SIs that are significantly affected by age and local health-care support systems. Early referral to specialists would help to alleviate anxiety and distress to the patient and family, even if currently delay does not influence outcome.     

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

A chronic illness, such as cancer, causes permanent changes in a person's way of life and their way of adapting to changes. The purpose of this study was to describe the coping strategies and resources of adolescents and young adults with cancer. The data were collected by interviewing adolescents and young adults aged 16–22 ( n  = 14) who had had cancer for more than 2 months and who came to a university hospital for treatment or control check ups. The interview material was analysed by content analysis. Emotion-focused, appraisal-focused and problem-focused coping strategies were used. The major coping strategies were social support, belief in recovery and getting back to normal life as soon as possible. The subjects discussed with health care providers their disease, its treatment and how they could cope with everyday life as well as their energy and will-power to cope. The family was the most important source of emotional support. Also, gaining knowledge about cancer and its treatment was a good coping strategy. Moreover, a positive life attitude, belief in one's own resources, belief in God, earlier life experiences and willingness to fight against the disease were resources for coping with cancer.     

Determining research priorities for young people with haematological cancer: A value-weighting approach

IntroductionHaematological malignancies account for a third of all cancers affecting adolescents and young adults (AYAs). Funding agencies are regularly faced with the dilemma of how to deploy resources in order to provide the greatest possible benefit to this patient group. This study used a value-weighting approach to quantify the stakeholders’ perceptions about how resources should be allocated to best improve outcomes for AYA patients and their families.MethodsOne hundred and fifty seven participants (112 health care providers, researchers and other professionals and 45 patients and carers) were invited to complete a web-based value-weighting questionnaire and indicate how they would allocate 100 units of funding among various research approaches, areas and populations.ResultsEighty participants (51%) completed the questionnaire. Strategic research was allocated a significantly higher proportion of funding than investigator-driven research. For research areas, clinical medicine and psychosocial research were allocated the highest proportion of funding. Within research populations, AYAs who were newly diagnosed, relapsed or finished treatment were allocated the largest proportion of funds. Psychosocial research which focussed on identifying risk and resilience, developing psychosocial measures, translating research into practice and improving the treatment centre was allocated funding slightly above other items, however the difference was not significant.DiscussionTo improve potential congruence between the views of stakeholders and funding agencies, research funding for AYA haematological cancer patients and their families could be targeted towards newly diagnosed patients and those who have relapsed. Research in the areas of clinical medicine and psychosocial care is perceived to be of utmost value.     

Care and support needs of children and young people with cancer and their parents

The importance of psychosocial support services for children with cancer and their families is recognised but evaluation of such services is less well developed with little information available about different patterns of provision. This paper provides an overview of psychosocial support children and their families in the UK receive during and after treatment. It reports the results of a postal survey of 303 families, within which parents and children identified their satisfaction with support services and also areas of unmet need. Satisfaction was identified in a range of areas, including medical information and support from nurses and social workers. However, areas of unmet need were also highlighted, especially age appropriate facilities, emotional support and information in different formats. Although British government policy currently seeks to develop standards and guidelines of care throughout the National Health Service, this paper demonstrates that there is still a need to develop psychosocial support services and work towards recently established guidelines in order to ensure that families receive flexible but equitable packages of care and support, wherever treatment is received.     

Oral cancer survival in young people in South East England

The incidence rate of oral cancer among young people in the UK has been increasing since 1970s. The objective of this study was to compare relative survival of young people (under 45 years of age) diagnosed with oral cancer with that of older people (45 years and older) resident in South East England. Between 1986 and 2002, 5 year relative survival was higher among young people compared with the older group, suggesting age was a strong independent predictor of survival. Apart from age other independent predictors of survival included stage, treatment and affluence but residence was not a significant predictor of survival in either age group. For the young age group (0–44 years) mean relative survival for the period under study was relatively constant but consistently higher in younger women than in younger men.     

Discursive constructions of youth cancer: findings from creative methods research with healthy young people

Purpose

As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance.

Methods

We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer.

Results

Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to ‘cancer victim’.

Conclusions

If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer.

Implications for Cancer Survivors

The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer.

     

青年人直肠癌的临床病理特征

目的:探讨青年直肠癌患者的临床病理特征。方法:回顾性分析2002年1月-2012年1月10年收治、行手术治疗的279例直肠癌患者的临床病理特征并进行回顾性分析,以40岁为界限,分为青年组(年龄≤40岁)和非青年组(年龄>40岁)。结果:肿瘤下缘距肛门距离≤7cm的比例占73.5%(205/279),病理类型以腺癌为主,占79.6%(222/279),细胞分化多呈高分化(33.3%,93/279)和中分化(43.0%,120/279),肝转移比率为10.0%(28/279),手术方式以根治术为主,占85.7%(239/279)。青年组患者直肠癌比率为15.1%(42/279),青年组患者黏液腺癌+印戒细胞癌比例、细胞低分化比例、Dukes D分期比例、淋巴结转移比例、肝转移比例及姑息切除手术和单纯结肠造瘘,均显著高于非青年组(P<0.01)。青年组患者肿瘤下缘距肛门距离≤7cm的比例为81.0%(34/42),高于非青年组,差异不显著(P>0.05)。结论:青年直肠癌患者具有直肠癌组织低分化、恶性程度高、易发生淋巴结转移和肝转移、就诊时分期偏晚、根治手术比例较低等临床病理特征。     

Hepatocellular carcinoma in young people

The clinical and pathologic features of 23 cases of hepatocellular carcinoma occurring in patients younger than age 35 years (mean age, 17.4 years) were analyzed. Ten of these (43%) were the fibrolamellar oncocytic variant (FLO), characterized by large polygonal neoplastic hepatocytes and lamellar bundles of collagen. The remainder (non-FLO) showed the usual wide range of gross and histologic patterns typical of hepatocellular carcinoma in older age groups. Overall, hepatocellular carcinoma was more common in females than in males. The FLO variant was characterized by a longer duration of symptoms prior to diagnosis, increased frequency of resectability of the tumor, and infrequency of mitoses. Of particular importance is the fact that 5 of 10 patients with the FLO variant are alive and clinically free of disease 1 1/2 to 8 years postoperatively, while none of the 13 patients with non-FLO hepatocellular carcinoma is alive and free of disease. There was no significant difference between the two groups in mean age at diagnosis, presence of single versus multiple hepatic tumors, vascular invasion, or tumor necrosis. Although cirrhosis was present in three non-FLO patients and none of the FLO patients, the difference was not statistically significant. The prognosis of hepatocellular carcinoma in young patients does not appear to differ from that in older patients, with the exception of the fibrolamellar oncocytic variant, a variant which is common in younger patients.     

78例青年人胃癌的临床诊疗过程分析

Objective： To summarize the causes of difficulty in gastric cancer diagnosis in young people and explore potential methods of improving diagnostic accuracy. Methods： We retrospectively analyzed 78 cases of gastric cancer in young people （14-35 years）. Results： The clinical manifestations of gastric carcinoma in young people show no specificity, and the initial symptoms were diverse, with discomfort in the upper abdomen as the main symptom. There are four causes of difficulty in early detection： （1） The previous physician relied on antacids and did not use or analyze the results of gastroscopic examination and barium meal examination of the upper digestive tract; （2） The physician performing the endoscopic examination did not strictly follow the standards in the biopsy of fine pathological changes in suspected early cancer; （3） The physician lacked a good understanding of the clinical progress of ulcerating-healing-ulcerating in the ulcerating type of early gastric cancer; （4） Lacked a good understanding of precancerous lesions in the gastric mucosa. Conclusion： Early gastroscopy and pathological examination must be conducted for people who above 20 years of age with one or more of the following symptoms： dull pain in the upper abdomen, anorexia, fatigue, tarry stool and vomiting of unknown origin. The results of gastroscopic examination should be taken into consideration for patients with recurrent ulcer, and biopsy should be standardized. Biopsy specimens should be taken from several loci in the suspected lesions, and should be repeated if necessary. Precancerous lesions of gastric mucosa should be closely followed up using gastroscopy.     

Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample

Abstract

Purpose: This study investigated levels of posttraumatic stress symptoms (PTSS) in children with cancer and their siblings from a British sample. It also examined aspects of the Ehlers and Clark¹ Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Beh Res Therapy. 2000;38(4):319–345.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar] model of posttraumatic stress disorder in the current population.

Methods: Sixty participants (34 children with cancer and 26 siblings) aged between 8 and 18?years completed measures of PTSS, maladaptive appraisals, trauma-centered identity, perceived social support and family functioning.

Results: Over a quarter of the sample scored above the clinical cutoff on the Impact of Events Scale-Revised. No differences were observed between patients and siblings with respect to levels of PTSS. Maladaptive appraisals and age were found to account for unique variance in levels of PTSS for the overall sample.

Conclusions: Rates of PTSS in the sample were relatively high. Support was found for aspects of the Ehlers and Clark¹ Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Beh Res Therapy. 2000;38(4):319–345.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar] model in explaining PTSS for the current population.     

Clinical assessment of elderly people with cancer

As the elderly population increases, the diagnosis of cancer will become more common than it is today, and difficult decisions about treatment will need to be made by various health-care providers. An important issue not only for patients but also for the whole health-care system is that only those who will benefit from therapy are treated. Individuals for whom treatment will add neither quantity nor quality to their lifespan should not be subjected to potentially harmful treatment. Many assessment scales are validated in elderly people but not used in elderly patients with cancer. Comprehensive geriatric assessment provides an overarching method of assessment before, during, and after treatment. The benefits and shortcomings of other assessment scales are discussed in this review, showing settings in which their use might be appropriate in the developing specialty of geriatric oncology.     

年轻人与中老年人的胃癌特征及预后情况的比较

目的:比较不同年龄段胃癌患者的特征和预后。方法:收集418名胃癌患者,病理确诊为原发性胃腺癌。其中有29名年轻患者［≤40岁,年轻组(YG)］和389名中老年患者［>40岁,年长组(OG)］。分析人口统计学和临床病理特征的差异。结果:相对于中老年组,在年轻病人组中,女性患者的比例较高。5年总体生存YG组比OG组要显著降低。然而,接受根治性切除手术后,YG组与OG组5年生存率没有显著性差异;年轻组显示女性患者生存率明显低于男性患者。肿瘤类型、侵入深度、腹膜转移、远处转移和根治性切除治疗是独立的预后因素。结论:早期发现,早期诊断,积极行根治性切除是提高年轻人胃癌治疗水平及预后的关键,尤其是在女性患者中。     

An analysis of risk factors for oral cancer in young people: a case-control study

The incidence of oral cancer amongst young adults is increasing in many European and high incidence countries. The aim of this study was to evaluate the major risk factors for oral cancer in young adults using a case-control design. A sample of 116 patients aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the south east of England were included. Two-hundred and seven controls who had never had cancer, matched for age, sex and area of residence, were recruited. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco products, cannabis, alcohol and diet. Conditional logistic analyses were conducted adjusting for social class, ethnicity, tobacco and alcohol habits. All tests for statistical significance were two-sided. The majority of oral cancer patients reported exposure to the major risk factors of tobacco and alcohol even at this younger age. The estimated risks associated with tobacco or alcohol were low (OR range: 0.6-2.5) among both males and females. Only smoking for 21 years or more produced significantly elevated odds ratios (OR=2.1; 95% CI: 1.1-4.0). Exposure associated with other major risk factors did not produce significant risks in this sample. Long term consumption of fresh fruits and vegetables in the diet appeared to be protective for both males and females. The results suggest that although this younger sample exhibit similar behavioural risk factors to older oral cancer patients, the low odds produced in addition to the relatively short duration of exposure, suggest that factors other than tobacco and alcohol may be implicated in the development of oral cancer in these younger patients.