Evidence-Based Practice of Treating Adolescents with Cancer - Essay Example

? A STUDY ON ASPECTS OF LIFE, ANXIETY AND DEPRESSION ON ADOLESCENTS DIAGNOSED WITH CANCER AND THE LIFE OF ADOLESCENTS LIVING WITH CANCER. By: Presented to: Institution: Date: Larsson’s Study This is a study that was conducted to investigate the kind of life that adolescents who are diagnosed with cancer live, how they are affected, whether their mental functioning remains the same, whether they are depressed and anxious taking that this is the age which is very crucial in their lives (Stam, Gootenhuis & Last, 2001; Barr et al, 1999; Apajasalo et al, 1996). It is at this age that youngsters are getting their education, they need to start long term relationships with partners, and it’s also at this age that some are choosing their careers so being diagnosed with a terminal disease like cancer can have a great effect on their physical and mental health. We aim to look deeply into the methods used in this research to come to a conclusion whether the results that are given are credible and whether we can be relied on. In this study a sample group of 61 adolescents diagnosed with cancer is used. This number is not good enough as there are many types of cancer and a larger group would have given better results. The reference group used to compare the mental health and vitality of the patients and the adolescents who were normal comprised of 300 young adults. Interviews were done by phone which brings in the possibility of lack of integrity. Though we can’t rule out the possibility that the adolescents interviewed gave correct information, they could also have given false information as there was no direct contact with the interviewer (Woodgate, 1999, Parry & Chesler, 2005). In the study we are not given the names of the adolescents who were interviewed. That speaks positively of the condition of anonymity required for social and scientific surveys. From the results, the adolescents diagnosed with cancer show reduced mental health and vitality, their depression levels are high compared to that of the reference group which shows higher levels of mental health and vitality and lower levels of depression. This report can be faulty taking that many of the patients receive treatment after a period of time and they are likely to undergo depression at such times due to the effect of the therapies. The adolescents can therefore suffer from low mental health and vitality for as long as they are undergoing the treatment and then the levels of mental health and vitality start rising once treatment is over. The results are collected up to 48 months after the first test. The study concludes that their mental health at that time is higher than that of the reference group. This is also a matter of probabilities as the adolescents suffer from other problems like lack of funds, they are unable to play well, some drop from school as their parents or guardians are not willing to continue paying for their fees, some feel isolated and also some feel that their parents are too caring always calling them to check whether they are safe and taking medication (Collins et al., 2000; Ware & Kosinki, 2001; Tedeschi & Calhom 2004). There are also other problems which come as a consequence of smarting from cancer like change of facial appearance and baldness which can make the adolescents’ esteem to be very low. This can cause lower mental health and vitality and can cause the levels of depression to be higher than that of the reference group. The increased mental health could have been attributed to accepting the situation and learning to live with it and also by efforts from counseling and guidance which are not mentioned in the study. There are other disorders that make the adolescents to have low mental health and vitality apart from cancer. The reference group that was used does not reflect such a situation. It is common to find adolescents who are suffering from diseases like diabetes and TB which as well will cause the levels of depression to rise. This means that at one time the reference sample may show results where the cancer affected adolescent reporting a high level of mental level and vitality and lower levels of depression and anxiety than an adolescent from the reference sample (Stevens& Parkes, 1998; Hind’s, 1990). Also, some of the adolescents could be undergoing counseling which in turn will help the patient’s mental health to remain high and such a patient wont experience depression and elevated levels of anxiety. The findings in this particular study fall in line with other similar studies. From the research by Erickson, Patterns of Adolescents Receiving Chemotherapy, we can conclude that the lower mental health and vitality could be caused by fatigue which is experienced after the chemotherapy. The patients experience periods of peak fatigue which come after undergoing the procedure. At these periods they can be depressed and become anxious thus explaining the results from the study done by Larson. But though the patients report experiencing fatigue, they still underwent and did normal things like reading, playing etc. Apart from fatigue, the adolescents experienced nausea and vomiting, pain (especially back pain) and sleep disturbance. All these can be factors that can lead to the fall in mental health and vitality and elevated levels of depression and anxiety (Eiser & Kope, 1992). This is because these factors make the adolescents not to interact well with the environment, friends and may be fail to do the things they had been used to. It can also affect eating habits which can lead to loss of weight adding to the depression. The fear of death can also cause the levels of depression to rise and mental health to lower. Erickson, like Larsson, cites the main types of cancer as Leukemia, Lymphoma and Sarcoma. Emma Ream in her Experience of Fatigue in Adolescents Living with Cancer notes that adolescents suffer from fatigue before and after treatment. A study in the Netherlands using a sample of 455 patients showed that 18% of the survivors of childhood cancer suffer from fatigue for the rest of their lives. These results were in line with Larsson’s as the quality of life is changed after suffering from cancer and recovering. Emma Ream’s Study The objectives of the study was to explore and compare the levels of fatigue in cohorts of adolescents either undergoing treatment or in the recovery stage (from cancer). The second objective was to look at the quality of life led by adolescents undergoing treatment or after treatment and lastly to investigate the feasibility of computerized data collection for adolescents with cancer. The research team used a structured diary to collect the information from the adolescents. The recruited group was 21. This is a very small number as it is less likely to give us the diverse information we need. It is also likely it did not cover the different types of cancer that is seen in the other studies. Gender and race were considered since they were more likely to give better information about inter-gender and racial exposure to certain types of cancer and the effects experienced. The names of the adolescents were included which adds credibility to the results that were obtained. However, this is not always right unless an express permit was given by the respondents. The majority, 59%, suffered from leukemia, 41% lymphoma and the rest solid tumor. This shows that other types of cancer were not represented. This can be as a result of the small number used in the study. From the study it is written that the stage of illness and the treatment impact on symptom experience and psychological well being are interlinked. This supports Larsson’s findings which show the mental health and vitality rising while the depression and anxiety levels decrease with time after treatment. It also concurs with Ann Grinyer’s study which shows that the fears one has after getting cancer go on decreasing as the individual becomes better in adapting to the new life with cancer while undergoing treatment and after treatment. In the first section of the study the diaries written showed that 71% of the adolescents complained of having distress from the cancer related symptoms, 32% of the total number complained of fatigue which still persisted even after undergoing and completing medication. This is against Larsson’s study which shows mental and physical health improving with time of treatment. 21% of the total number experienced pain. Pain can really cause distress which can make the adolescent not to be able to interact with the society well. 20% experienced nausea and vomiting, which can cause physical problems like weight loss, which in effect lower the mental health of the adolescent leading to depression. The data was collected electronically; it showed that although the adolescents experienced fatigue they were able to go through their daily activities without problems. The daily activities included playing, learning and socializing with their friends. The sample used was relatively small thus the results that were collected were very limited and they could have failed to vindicate the real situation of the adolescents who are diagnosed with cancer and how their lives are. Representation of these samples cannot be assured as data was collected for just one week which could have excluded a lot of information and experiences that were going on during the entire treatment period. According to the author the results were lent credible. To make the results better in another study the reference group and the sample should be large. This will ensure that many types of cancer are covered and it will also help to bring out all the symptoms which come with the different types (Mock et al, 1992; Waker & Greane, 1991). Large groups of adolescents should be followed up to the time they gain understanding and rehabilitation. It should be noted that cancer can have many adverse effects on the adolescent as even those who were treated successfully experienced fatigue even after completion of treatment. This shows it can have lifelong effects which will be making the physical and mental health of the person rate low. Also, other effects of cancer like baldness and change of facial appearance can make the adolescent to lose self esteem which in turn will make him or her fail to interact properly with other people. This can thus lead to a low level of mental and physical health. On the other hand this should not rule out the possibility of some of the people studied recovering well and not experiencing fatigue, pain, nausea or vomiting and general wellbeing. Some still recover well and live normal lives without the effects left by cancer. This concurs with Larsson’s study on mental health of cancer diagnosed adolescents. Another shortcoming of this study is that the different cancer cases have not been dealt with independently. It should be known that the different types of cancer will cause different symptoms and also the kind of treatment is not the same. So by studying the experiences together one may not get the correct information on the effects of cancer and the experience of fatigue on the adolescents (Ritchie, 1992; Richardson A., 1995; Wolfson, 1998). The different effects of a particular treatment need to be studied alone as when studied in general we may not end up getting the experiences as they originate from each of the types of cancer. This should be done in detail as the current results may be misleading. A large control group also needs to have been used. The normal adolescents (the ones not suffering from cancer) could also be suffering from other diseases which could make them feel fatigue so by assuming that all of them were uniform at the time of the study is wrong. The results must be able to show such deviance from the norm. Ann Grinyer’s Study Ann did a study on the impacts of cancer on teens and adolescents. Her objective was to research and find the experience of having cancer in adolescents and young adults. She also wanted to see the kind of life led by people who get cancer at teen-age or adolescence and then they recover well. She used an impressive method of collection of information where the adolescents with cancer were each interviewed physically while some were requested to write short narratives to express their experiences. This method is effective as the interviewer is able to tap more information unlike in the methods of collection of information used in the previous researches. The results of this research exhausted all the life experiences that the cancer patients went through as they recovered and after recovering. Cancer is a chronic and life threatening illness especially when one gets it at adolescence which is a transitional stage from childhood into adulthood. When one is diagnosed with cancer they suffer mentally and physically (Grinyer, 2002; Miles & Huberman 1994). Also, when one is receiving medication they suffer from implications which come as the effect of the type of treatment they are subjected to. Her research question, which the interviewees were supposed to respond to, was also catching. She asked ‘how is it like to be a young adult with cancer’. The participants were from two hospital trusts. One from a special teenage ward and the other was from the general oncology unit. Her research explains the results from the other studies done by other researchers. From the results the participants express the following fears; fear of getting jobs. At this age many adolescents are in the course of choosing their careers (Glaser & Strauss, 1967; Grinyer, 2002). There is one participant who suffered greatly on realizating that he was not to participate in the 2012 Olympics’ and if he was to participate it could be in the Paralympics. This was as an effect of cancer. This was really bound to result in low mental health, suggesting that Larsson’s findings were correct. Others had their facial appearance changed. This can make the participant to lose self esteem and live in a dejected life. For those who undergo chemotherapy there is a possibility of being infertile there after. This can cause distress to the person even after they recover from cancer. In men sperm banking can save the situation such that even after the therapy they can still sire some children. But in women, egg harvesting is invasive and it may cause more problems so it is not advocated for. The parents of the cancer patients also feel that they need to take greater care of them and so they impart a lot of pressure which the adolescents and the young adults don’t like. At this age the adolescents are trying to start making relationships which will last in their lives. With cancer some of these dreams do not come true. This is because they are at many times unable to interact well with other people. This could have been caused by the time they spend receiving treatment and also the effects left behind by cancer like the facial appearance being detrimental. The mental state deteriorates as one is not sure whether they will recover or succumb to the disease. On the ethical part of the practice of collection of sperms and storing them, it may not be accepted in the society but it gives an option to living an infertile life as one can still use the sperms in the future after recovering to get children. There is also the problem of finance as some of the interviewed participants cited. When they were receiving treatment some did not have money and they were not working, giving them a hard time financially (Robson C, 1995). In comparison with the other studies, Bury’s can be used to explain the results of the mental health and depression rise or fall by looking at the kind of life that the person is living when under treatment and after recovering. When one is not settled they are susceptible to mental health and vitality than a person who is settled (Kvale, 1996; Grbich, 1999; Bury, 1982). All the examples given can serve to show the kind of life that these people go through. In conclusion, the paper gives an overview of the main findings on the research on the young adults and the adolescents who have cancer. It has also helped to answer the question why the group is different from the others who are not suffering from cancer. Jean Eriksson’s Study: Patterns of Fatigue in Adolescents Receiving Chemotherapy The objective of the study was to describe the patterns of fatigue in adolescents and the impact of fatigue during one month of chemotherapy by studying the variables that affect fatigue and explore the feasibility of collecting daily self report data on the population being studied. The studied group’s age ranged from 12-19 years. The participants were allowed to participate at their own will. They were also supposed to know how to read and write. This criteria was not used in any of the other studies. The first group consisted of teens who were undergoing chemotherapy every 3-4 weeks. The second group consisted of those who received chemotherapy after every two weeks. 32 participants were invited to the study. 25 i.e. 78% went ahead to participate. This group was relatively small and the results that could be collected from it were bound to be skewed. Four of those who enrolled were not cooperative and so their results were nullified. This led to further limiting of the sample. The common diagnoses were Lymphoblastic Leukemia, Hodgkin’s Lymphoma and non Hodgkin’s Lymphoma (Youngblunt & Casper, 1993). The data collected as not significantly different from the one collected in the previous studies on the most common types of cancer (Hockenberry & Hook 2007). However, by discussing just two types the results expected would not cover the various types of cancer. The study was taken for 5-17 weeks. The results indicate that the participants claimed to experience fatigue. This can be due working hard, spending a lot of time sleeping and the complications brought about by the therapy. Others used to travel far while going for the therapy and that also left them fatigued. Apart from fatigue they also experienced cancer related symptoms like nausea, pain and sleep disturbance. The cause of fatigue could be due to being very active, and their lifestyles; maybe exercising a lot (Breetvelt & van Dam 1991). During the days the fatigue hits peak participants are less active finding it hard to even do normal activities. At such periods they slept all the day. They got relief from improved oral intake, sleeping and resting, decreased activity and improved social interactions. In the discussion it showed that all the adolescents who were either in their second or third month of chemotherapy showed fatigue in all their months of treatment. This could not be correct as the data used was relatively too small, but a great number of adolescents show fatigue when undergoing chemotherapy (Tebbi C, Petrilli A, Richards M, 1989). The fatigue varied with the type of cancer one had, being relatively higher among those with breast cancer. Adults with cancer recorded more fatigue than the young ones. This brings out the aspect of age which is barely discussed in the previous researches. Fatigue and lack of socializing can be a major factor in the lowering of mental health and vitality as reflected by Larsson. It can also cause depression which will cause further physical and mental health depletion (Langeeld, Ubbikim & Smets, 2000). This study has been done well but it could have brought out a better image if the sample was larger. A reference group is not used thus making comparison of the results impossible. Bibliography Apajasalo, M., Sintonnen, H., Siimes, A., 1996. Health Related Quality of Life of Adults Surviving Malignancy in Childhood. Barr, R., 1999. On Cancer Control and the Adolescent. Breetvelt, I., Van Dam, F,. 1991. Under reporting by Cancer Patients: The Case of Response Shift. Bury, M,. 1982. Chronic Illnesses as Biographical Disruption. Social Health Illness. Collins, J., Byrness, M., Dunkell, J., 2000. The Measurement of Symptoms of Children with Cancer. 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