Annals of Oncology Advance Access originally published online on June 23, 2009
Annals of Oncology 2009 20(10):1722-1727; doi:10.1093/annonc/mdp066
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quality of life supportive care |
Empirically derived psychosocial states among adolescents diagnosed with cancer during the acute and extended phase of survival
1 Department of Public Health and Caring Sciences, Psychosocial Oncology and Supportive Care, Uppsala University, Uppsala
2 The Vårdal Institute, Lund University, Lund
3 Department of Public Health Sciences, Karolinska Institutet, Stockholm
4 Department of Psychology, Stockholm University, Stockholm
5 Department of Women's and Children's Health, Paediatric Oncology, Uppsala University, Uppsala, Sweden
* Correspondence to: Dr E. Mattsson, Department of Public Health and Caring Sciences, Psychosocial Oncology and Supportive Care, Uppsala University, Uppsala Science Park, S-751 83 Uppsala, Sweden. Tel: +46-18-4713508; Fax: +46-18-4713490; E-mail: elisabet.mattsson{at}pubcare.uu.se
Background: To, during the acute and extended phase of survival, identify psychosocial states among adolescents diagnosed with cancer and to analyse these in relation to demographic and clinical characteristics and self-reported depression.
Patients and methods: Participants completed the Hospital Anxiety and Depression Scale and two subscales, Vitality and Mental Health, in the SF-36 4–8 weeks (T1) (n = 61), 6 (T2) (n = 57), 12 (T3) (n = 50), and 18 (T4) months (n = 48) after diagnosis. I-State as Object of Analysis was used to identify a finite set of states based on three dimensions. Cluster analysis was carried out using Ward's method.
Results: Five states were obtained: psychosocial dysfunction (state A) and poor (B), incomplete (C), good (D), and excellent (E) psychosocial function. At T1, more adolescents than expected by chance were in states A (P < 0.05) and C (P < 0.01) and fewer in states D (P < 0.05) and E (P < 0.001). At T4, more adolescents than expected by chance were in state E (P < 0.001) and fewer in state C (P < 0.05). Female gender and being in late adolescence when diagnosed is related to worse psychosocial function.
Conclusion: The findings provide support for subgroups of adolescents whose level of vitality, mental health, and anxiety differ during the acute and extended phase of survival of cancer. Clinical interventions tailored to the level of impairment as determined by the clusters may result in better psychosocial outcomes.
Key words: adolescents, cancer, cluster analysis, HADS, psychosocial function, SF-36
Received for publication April 11, 2008. Revision received November 8, 2008. Accepted for publication February 23, 2009.