While it is great that the survivor rate has and is steadily increasing year after year the intense curative therapy that is given to produce the high rates of survivorship can cause long-term effects on the body including psychological and psychosocial deficits. Based on the juvenile knowledge gained from previous studies, it is understood that some, but not all children with hematological malignancies develop late effect psychological and psychosocial deficits but it is unclear the exact cause of the deficits and the extent that those deficits may have on a survivor’s life.
Search Process: DePaul WorldCat Local, PubMed, and CINAHL Complete databases search was performed. The following Medical Subject Heading (MeSH) terms and search details were used and the Boolean operator AND was utilized to get a highly relevant search yield: psychosocial adjustment AND hematologic neoplasms. CINAHL Complete search was completed using the following search terms: psychological AND survivor AND blood cancer. The search yielded 31 and 22 articles for PubMed and CINAHL Complete, respectively. DePaul WorldCat Local search was performed using the following search details: psychological deficit and cancer survivor and hematology. It yielded 179 articles. All abstracts were reviewed one by one independently by two researchers. Articles were included in the final analysis if they reported on psychological or social deficits and the patient population includes pediatrics, adolescents or young adults 21 years of age or below when diagnosed with a blood cancer. Year limit was between 1990 and 2016, and articles that focused on cognitive issues were excluded. Articles that reported psychological deficits in adults aged 21 years and older were also excluded. The final 34 articles used in this integrative literature review (ILR) were categorized by level of evidence according to Melnyk and Fineout-Overholt’s hierarchy of evidence (2011) to appraise the strength of evidence for reported psychological and psychosocial deficit and their risk factors. Whittemore and Knafl (2005) updated ILR methodology was strictly followed during the conduct of this review.
Results: A total of 34 papers with 17812 pediatric hematological cancer survivors who exhibits psychological and social deficits were incorporated in our ILR review. The weighted median age at diagnosis was 8.95 years. Of these 34 articles, 5 articles whose ages could not be used (due to being an open age range) and 2 are literature reviews, were also excluded for the median age calculation to avoid duplication. The mean follow-up time was not calculated at this time due to too many missing data from published papers. Data were analyzed using SPSS version 21. Incidences of depression (58.8%), Anxiety (44.1 %), Mood problems (32.3), Poor psycho-social domains in global QOL measure (32.2%), Social problems (26.4%), Attention problems (20.5%) Behavior problems (14.7%), Post-traumatic stress syndrome (11.7%), Conduct problems (11.7%), Risky behaviors (8.7%) were higher among pediatric hematological cancer survivors than in the normal population or matched controls. A comprehensive list of these deficits can be found in Table 1. The top risk factors found to be statistically correlated to psychological and social deficits among pediatric hematological cancer survivors include high intensity chemotherapy, total body radiation, cranial radiation, being a female, being younger in age, dysfunctional family, and stem cell transplantation. Table 2 outlines all risk factors reported in the literature. Beck depression inventory and SF-36 were the most common measures used to identify psychological and social deficits.
Table 3 presents the strength of evidence for the reported psychological and social deficits is strong based on Melnyk-Fineout-Overholt's hierarchy of evidence (2001). Fifty two point nine percent (N=18 studies) of the studies were conducted using RCT, matched case control, siblings as control or population control study design. The remaining 47% percent of the studies (N=16) included single descriptive or qualitative studied. This study underscores the importance of developing effective interventions that address the psychological and social deficits among pediatric hematological cancer survivors.
See more of: Invited Posters