Fatigue in Adolescents with Cancer - Literature review Example

? Literature Review Fatigue in Adolescents with Cancer Introduction and Background Cancer in adolescents is quite prevalent in the contemporary period. There are modern studies which describe that how intensively cancer influence adolescents (Carroll, 2010). There are different influences which cancer brings for the adolescents like in different stages of cancer the adolescents catch social, psychological, physical and spiritual influences. It is actually -diagnosis, which brings impressions for adolescents changing their lives in the most disturbing manner (Carroll, 2010). This chapter is a review of the literature on how adolescents are influenced by cancer i.e. how they suffer and what fatigue they carry at the time of the disease (Grinyer, 2009). It is going to review the life of the adolescent cancer patients and their methods to cope up with cancer and caner influences. The review will be made in the light of the contemporary literature and in the scope of the present medical understanding (Carroll, 2010). Literature Review Theoretical Framework Quality of Life and Fatigue for Adolescents in Cancer When medical practitioners talk about the quality of life, they relate it to the quality of mental-physical state of a person. If a person’s health is affected or shows poor quality, definitely it brings poor quality of life having the poor quality of health. (Albert et al., 2002; Revicki et al., 2000; Sajid, Tonsi, Baig, 2008) describe the quality of life as health related the quality of life which gets poor when the health of a person is in bad shape or bad condition (as cited in Eilertsen et al., 2012, p. 1). Adolescents having cancer abide in the poor quality of life situation, as they are continuously intervened by most painful and severe disease influences (Rashideh, 2013). A slightly different view comes from World Health Organization, which describes the quality of life as a psychological situation in which the person is happy, satisfied and socially active (Eilertsen et al., 2012). In such a perspective, the quality of life of an adolescent cancer patient is what signifies happiness, contentment and satisfaction in the adolescent’s behavior. This is one psychological concept which the literature highlights for adolescents surviving chronic cancers – tuberculosis, Melanoma, Leukemia, or Non-Hodgkin Lymphoma (Carroll, 2010). According to the contemporary medical research, the chances of adolescent survival in cancers by psychological treatments have increased, due which the activities regarding understanding the psychological concepts “quality of life” have increased too (Kelly, 2008). The medical practitioners for bringing up the effective care have come along to understand adolescents’ psychosocial consequences in-relation to the quality of life for surviving the cancer (Kelly, 2008). This is to give a close understanding on the concept of QoL which significantly relates to the adolescents’ survivorship pattern (Elizabeth, 2011). Meanwhile, the other majority of the practitioners are on the basic treatment procedures. They are concerned about the reduction of pain, difficulty and physiological fatigue which a cancer patient normally carries (Eilertsen et al., 2012). The contemporary literature of medicines gives a subjective explanation about adolescents’ the quality of life in cancer. There is no specific or clear definition about the concept, therefore the literature sticks to give broad and subjective explanation about the concept of the quality of life (Gibson, 2003). From a broad view, QoL can be classified in two types, psychological QoL and physiological QoL (Eilertsen et al., 2012). In this way, the literature uncovers two basic classifications which indicate that when an adolescent is in the survivorship period, it has both psychological and physiological fatigues affecting his or her psychological and physiological qualities of life (Eilertsen et al., 2012). Cancer fatigue relates to the quality of life. It has a direct association with both psychological and physiological qualities of life. When an adolescent is diagnosed with cancer, he or she inevitably comes to psychological and physiological fatigues (Rashideh, 2013). Fatigue is for the patient and also for the patient’s family bringing them the physical, psychological and economical stresses (Harvard Health, 2008). Most frequently fatigue has been associated to survivor’s social group like parents who are distressed and are found indulgent in patient’s right treatment and recovery (Harvard Health, 2008). Nowadays oncologists are focusing on the fatigue management for both adolescents in cancer and their parents and peers (Harvard Health, 2008). There are conducts developed and organized to manage fatigue right from the first instance. This covers both management of patients-parents psychological and physiological fatigue (Tolle, 2009, p.219). Adolescents Psychological Fatigue in Cancer (Effects on Quality of Life) In the modern research and understanding, there are different psychological affects which young cancer patients have during the survivorship period (Gibson & Soanes, 2008). There are influences such as separation anxiety, depression, stress, and sometimes, fear and paranoia (Gibson & Soanes, 2008). It depends on adolescents’ cancer state and also on the coping capability that how the patient resists and restricts cancer at the time of development. Apparently, the literature is unable to decide that which of the affects are frequent and which not. It is because every patient is different from other patient (National Cancer Institute, 2013). Each has a different psychological state, personality, and characteristics. This makes the research contradictory as the early and the late psychological effects are not precise and frequent to describe in all the adolescent cases (Wallace & Green, 2004). In most of the young cancer patients’ cases, patients along with their parents both get enervated. They retire from the normal state and not want to face the situation if it gets more critical or more challenging (Wallace & Green, 2004). Definitely, cancer is a challenge for both the adolescent and parents but it requires an utter strength to fight back and to cope up (Grinyer, 2009, pp.2-5). This is what many psychologists and doctors believe that if an adolescent is well prepared both emotionally and from the inside, he or she has a more chance of good survival with improved quality of life (Eden, 2008). In respect of the modern literature, adolescents found with cancer are naturally in the suffering process. They pass from different levels of suffering, where each new level is more critical than the previous one (Grinyer, 2009). The question that often comes around is that where suffering comes from like where it develops in a young patient’s mind (Grinyer, 2009). There are different studies to answer such a question like some studies claim that it comes from the “diagnosis”, which actually identifies that the person is carrying life’s deadliest disease (Grinyer, 2009). This fact is the most accepted one as far as psychologists are concerned and as other medical practitioners and researchers have thought about. Definitely, when an adolescent gets diagnosed and get informed by the disease he or she naturally will come into the state of suffering. This is one psychological affect which invites poor quality of life for an adolescent in cancer (Elizabeth, 2011). The European Journal of Cancer published a study with indicates one similar fact that when an adolescent is told that he or she is living with cancer, the patient inevitably accepts suffering for the rest of his or her life. The study of (Gibson, 2003) from the European Journal of Cancer indicates that diagnosis is a natural exhibitor of suffering. It is an exaggerator of suffering which intrudes it to the patient’s mind, his or her mental-physical state and next to the behavior (Larsson, 2010). On accepting suffering, the patient gets retired from the normal state of mind and starts to adapt tiring habits i.e. habits which make his or her life slow, stopping and discontinuing (Gibson & Soanes, 2008). Therefore, suffering when arrives for adolescent it naturally takes away the hope and motivation to survive. It takes away the hope and the will to fight cancer with its deadliest influences (Engels, 2011). According to (Carpentier & Mullins, 2008), losing hope is what organizes distress, anger and frustration in a young’s mind. A believe that (no matter what treatment is made a cancer patient dies) breaks up the adolescents from inside (Carpentier & Mullins, 2008). This is one natural influence of cancer, which occupies an adolescent’s mind, making him or her obsessed from life while losing effort, patience and will all at the same time (Carpentier & Mullins, 2008, p.106). Adding to this, Dr. Pamela S. Hinds who had been a medical researcher, describes an adolescent cancer patient as a patient who cannot talk, smile, move or think (as cited in Peggy, 2005, pp.2-3). According to Dr. Hinds, a 15 year old cancer patient takes a long time to bring a smile on the face. This is a severe stage of despair which Dr. Hinds describe with her medical experience, apprehensions and understandings (as cited in Peggy, 2005). Moreover, in the experience she had found that teenage cancer patients bring pause in their physical activity. They feel tiresome all the time, and not in a habit to move, walk or exercise. This is all the suffering which young cancer patients experience at the time of their cancer stage (Peggy, 2005). There is a critical viewpoint in this understanding that adolescents lose hope by themselves. As many specialists like (Carpentier & Mullins, 2008) have talked about, that despair comes naturally from inside and not from outside, especially when a person is in life’s chronic disease- cancer (Eilertsen et al., 2012). This gets opposed but other experts who believe that if hope is given from outsiders like from social groups (friends, peers, parents and doctors) it motivates the patient to kill its internal despair. This helps the adolescent to survive and to fight till the last breadth and the last moment (Eden, 2008). Adolescents are in the developing mind process, specifically the teenagers in between age group 15 to 21 (Gibson & Soanes, 2008). They need guidance, support and encouragement to defeat life’s most chronic cancer. If they are given external hope, like from parents, friends, doctors and the social group people, they have a more chance of good survival with an improvement in the quality of life (Carroll, 2010). Cases in United States, Oklahoma and Texas indicate that most of the young cancer patients reduce their physical activity. As the doctors recommend that a 60 minute walk per day is essential for a cancer patient, which adolescents avoid at each level of their cancer period (Carpentier & Mullins, 2008). So analyzing the overall doctorial perspective, it can be said that young cancer patients do not only lose hope but they also forget the normal routine of life and the normal way of living. According to (Carpentier & Mullins, 2008), there are cases in which adolescents do not want to take part in weight management activities. Controlling the fat and restricting the caloric intake is not in interest of young cancer patients (Gibson, 2003). They become regardless of self-caring, managing health, body weight or any other physical development. These are the psychological affects which adolescents find time after time during cancer (Carroll, 2010). Adolescents Sociological and Physiological Fatigue in Cancer (Effects on Quality of Life) To understand the sociological fatigue in young cancer patients, there are lots of researches made in the recent times. The contemporary literature uncovers that there are late affects in adolescent cancer patients’ life, which changes their sociological setting. There are cases reported in which the social quality of life of children in cancer is highly affected. (Wallace & Green, 2004) projected that there psychological affects in children behavior facing severe cancer illness (as cited in Elizabeth, 2011, p.9). (Eiser, 2007) have recognized that most of the young survivors face a great problem in attaining “normalcy” as they are in the mid of living and surviving during the cancer illness (as cited in Elizabeth, 2011, pp.9-15). With dosage of certain cancer drugs and hard treatments (cardiomyopathy, chemotherapy, radiation fields), there are cases of neuropsychological and cognitive dysfunctions in young cancer patients (Carroll, 2010). On further, there are cases in which children have obesity, hearing, along with dental dysfunctions. In such cases the children start to get disconnected from the normal social life and from the normal social behavior (Tolle, 2009). Interaction from the outer world gets poor and normal communication with peers and parents is slowed down in each criticality. Contradicting to the understanding, the literature also project cases where adolescents are sent back to their normal routines i.e. to their schools, work and job in which they are well adjusted and coped with the social environment (Tolle, 2009). There are cases in which children are sent back to their homes, out of the pediatric environment, in order to get settled and adjusted to the normal social environment (Grinyer, 2009). This is to improve the social behaviors of children with natural implication of pediatric service and treatment. Adjustment to the social environment is recorded poor, when a young is diagnosed with critical stage developed neoplasm (Elizabeth, 2011). This is one form of cancer where the patient first has primary neoplasm and after some time the distinct second neoplasm comes back, which gets severe time after time. These are all what medical practitioners call the symptoms of young cancer patient- the somatic physical and psychosocial late affects of a young cancer (Elizabeth, 2011). With late physiological and psychological affects, there is a psychological strain developed for both the adolescent in cancer and for parents of the child. Being less aware of what will happen next, both parents and child get on with psychosocial stress with a possibility of child’s psychosocial dysfunction (Eden, 2008). This is the uncertainty of the future relapse and the possible late affects is what bring the social gap in the adolescent’s life and parents (Carpentier & Mullins, 2008). This on the other side gets contradicted, when survivors deal with therapy challenges and illness strain, occupying the normal social behavior and normal social life (Elizabeth, 2011). Meanwhile, there are literature projections in which young have learning disabilities, weak cognitive functioning, and risk of high anxiety, depression and psychosocial stresses. The literature describes that when adolescents are uncertain about their future living in cancer, they bring solitude and isolation in their behaviors. This is how they try to be abandoned from the outer world and the social life and setting. (Eiser, 2007) projects that young cancer patient face difficulties in social interaction i.e. making new friends or interacting with the old social peer group (as cited in Elizabeth, 2011, p.9). This is a stage of isolation which is often reported in adolescent cancer survivorship period. These are further late sociological affects which are reported time after time in literature for the adolescent cancer survivorship period. Lansky, (1978) reports traumatic stress, Mott (1990) highlights cognitive difficulty, and Eiser & Ishida (2010) report reduced social interaction and poor quality of life for adolescent in cancer (as cited in Elizabeth, 2011, pp.10-15). Adolescents in Cancer and the effort to turn back Normal According to the modern literature, there are growing cases where the children in cancer are returned to their daily life routines (Corner & Bailey, 2009). To bring normalcy in the children behavior the practitioners suggest that children return to their normal daily routines. Returning back to school or to work is highly significant for adolescents in cancer (Corner & Bailey, 2009). Attending the school is a kind of work for an academic adolescent in cancer. The school retry is one method of treatment for young cancer patients. This is an added valuable method of treatment, as per the literature projections and many of the specialists describe in their medical experiences (Brimeyer, 2012). Returning to school is a way in which the child can have social and academic development, which is important for coping and for controlling the psychosocial fatigue of cancer. When children are sent back to their normal life routines, they held the experience of a normal life setting (Brimeyer, 2012, pp.5-10). Adjusting normalcy is important for both the children surviving cancer and for parents who are in deep in mental-physical stress due to their children illnesses. Such reasons affirm that school-retry and work re-integration are methods of coping and managing fatigue for adolescents surviving cancer (Brimeyer, 2012, pp.5-10). Conceptual Framework According to Eilertsen et al. (2012), fatigue in adolescent cancer patients is multi-factorial and multidimensional. Fatigue in young cancer is a troublesome symptom which holds a lot of subjective meaning. The study conducted analysis on the basis of 50 children cases, uncovering the explainable meaning of fatigue and quality of life in adolescent cancer patients (Eilertsen et al., 2012). The study found that fatigue is a frequent symptom in young cancer affecting the quality of life of the cancer patients (Eilertsen et al., 2012). The study indicates that in young cancer, fatigue is dissimilar and different in all the cases reported. Every case is different and exceptional from the other in adolescent cancer. In concise way, the study describes that fatigue of an adolescent in cancer is all what the adolescent experience at the time of diagnosis and at the period of survivorship (Eilertsen et al., 2012). It could be social disintegration, poor interaction, or psychosocial dysfunction that describes adolescent fatigue in cancer. In this way, every case has a new experience and every case has a new meaning of fatigue and fatigue implications (Eilertsen et al., 2012). There are studies which relate quality of life of an adolescent in cancer with psychological influences. The studies project that when an adolescent is diagnosed with cancer illness, he or she is found with psychological illness, reducing the quality of life and life activities (Larsson, 2010). The study of Larsson (2010) with a sample size of 61 adolescent patients reported anxiety and depression in patients. Using HADS anxiety subscales, the study found that after 6 months of diagnosis, the mental health of a patient is recorded weaker with a higher level of anxiety and depression. After 18 months of diagnosis the depression gets down but the mental health is more weak and poor. After 48 months, which is a big period patients reported highly reduced level of depression and anxiety state (Larsson, 2010). This brought the conclusion that psychological effects are higher at the early period of diagnosis and lower at the late time of cancer development. This is what calls out fatigue for adolescent cancer patients, where mental health state changes time after time and stage after stage during the cancer (Larsson, 2010). The study by Engels (2011) indicated that psychological influence during cancer depends on adolescents’ personal level of coping and personality characteristics (Engels, 2011). There are some teenagers which have a better coping mind, dealing with the challenges well earlier and at the later stage of cancer. But there are others, which fear and distress, are in a poor state of coping with a reduced quality of life. So, it depends on how an adolescent is evolved at the personal level and at the social level to cope up with cancer stresses and challenges (Engels, 2011). Definitely, the surroundings play a major role like from if the social group, parents, peers, doctors, and facilitators give hope, guidance and support, the adolescent is more ready to face chronic illness of cancer. This is how the indifferent environment of coping and stress management changes the quality of life and the quality of adjustment of the patient (Engels, 2011). Using the data from thirty three standard schools, the study found that when adolescents are provided with effective guidance and support from parents and pediatrics, they are with improving coping capability with improved quality of life (Engels, 2011). It found that as the environment of coping is changed; like it gets poor it affects an adolescent personal level of adjustment during cancer (Engels, 2011). The study of Servitzoglou (2009), focuses more on the pediatric care. It projects that when a patient is found with poor environment of oncology and facilitation, it does affect its overall coping capability (Servitzoglou, 2009). The study projects that with dramatic progress of treatment procedures and services, there are increased number of survival cases of adolescent cancers. The exception is there for chronic cancers like brain tumors, or bone marrow transparent, where survival rates are lower even with quality facilitation (Servitzoglou, 2009). Using statistical method of analysis, the study found that oncology and pediatric treatment is a major section of improvement (Servitzoglou, 2009). Definitely, it is one section that has a major association to patients’ successful survivorship and hence needs to be improved at all the operational and managerial levels (Servitzoglou, 2009). Meanwhile, the study drafted the conclusion that in adolescent cancers the physical, psychological and social difficulties are quite subsequent and prevalent (Servitzoglou, 2009). The influences can be reduced, if each segment (oncology, pediatric, parents, peers and society) is doing well at its level, bringing the high in-depth moral and social support required for the survivor to survive. This is a natural phenomenon that needs to be understood and adjusted by each of the support segments of the survivors (Servitzoglou, 2009). Summary and Conclusion Adolescents having cancer abide in the poor quality of life situation, as they are continuously intervened by most serious and severe disease – cancer. World Health Organization describes quality of life as a psychological situation in which the person is happy, satisfied and socially active. QoL is one psychological concept that relates to adolescents’ psychological and social life behaviors. In this way, the literature uncovers two basic classifications of QoL, which are psychological and physiological fatigues affecting patient’s psychological and physiological qualities of life. In the modern research and understanding, there are different psychological affects which young cancer patients have during the survivorship. There are influences such as separation anxiety, depression, stress, and sometimes, fear and paranoia. It depends on adolescents’ cancer state and also on the coping capability that how the patient resists and restricts cancer at the time of development. The contemporary literature uncovers that there are late affects in adolescent cancer patients’ life, which changes their sociological setting. There are cases reported in which the social quality of life of children during cancer is highly affected. There are cases in which the young survivors face the problem in attaining “normalcy” as they are stuck in between living and surviving at the time of cancer development. The influences can be reduced, if each segment (oncology, pediatric, parents, peers and society) is doing well to bring the high in-depth support for the survivor in cancer. List of References Brimeyer, C., 2012. The Adolescent with cancers schooly re-try experience. Research Report. Iowa : Iowa Research Online University of Iowa. Carpentier, M. & Mullins, L., 2008. Adolescents with cancer: the influence of close relationships on quality of life, distress, and health behaviors. New York: Cambria Press. Carroll, W., 2010. Cancer in Children and Adolescents. New Delhi: Jones & Bartlett Learning. Corner, J. & Bailey, C., 2009. Cancer Nursing: Care in Context. Malden: John Wiley & Sons. Eden, T., 2008. Cancer and the Adolescent. Oxford: John Wiley & Sons. Eilertsen, M., Jozefiak, T. & Indredavik, M., 2012. 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