الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
C
ancer is a group of disease involving abnormal cell growth with the potential to invade or spread to other parts of the body (Cumming, 2014), According to National Cancer Institute at the National Institutes of Health The most common types of cancer seen in adolescents are lymphoma, leukemia, germ cell tumors (including testicular cancer), melanoma, and central nervous system tumors, sarcomas (Kamimura et al., 2018).
Aim of the Study
This study aims to assess the effect of physical changes related to chemo and radio therapy on psychosocial status of adolescents with cancer.
1- Technical design:
Research design:
A descriptive design was utilized to conduct the current study.
Research setting:
This study was conducted at Pediatric Oncology Ward in Children Hospital affiliated to Ain Shams University Hospitals.
Subjects:
A purposive sample composed of 240 adolescents with cancer according to sample size formula
(Chow, et al., 2007)
Who attended to previously mentioned setting and under the following criteria.
Inclusion criteria:
• Age from 12-18 years.
• from both sex.
• Confirmed diagnosis with cancer from one year.
• Undergoing chemo and radiotherapy and appear the physical changes on their bodies.
• Attained in the previous setting to follow up.
Exclusion criteria:
• Terminal ill adolescents.
• The adolescents undergoing bone marrow transplantation.
• Free from chronic disease.
• Any neurological disturbance.
Tools of data collection:
Data was collected through the following four tools:
I- Interview questionnaire format (Appendix I):
It was developed by the researcher based on O’Leary (2014), written in simple Arabic language by the researcher after reviewing the related literature and reviewed by supervisors. It consisted of two parts:
Part 1: a- It concerned with characteristics of the studied adolescents including age, gender, educational stage, ranking and residence.
b- It concerned with diagnosis, type of treatment received, duration of treatment, previous surgical operations and post-operative scar.
Part 2: Physical assessment sheet to assess physical changes related to chemo and radiotherapy of adolescents with cancer which included; respiratory system, digestive system, nervous system, urinary tract system, musculo-skeletal system, hair, vision, skin and other observations.
Appendix II: Assessment of adolescents, psychosocial status:
a- The Children Depression Symptoms Inventory 2 (CDI2)
It was adapted from Kovacs (2010), and translated into an Arabic language to assess manifestations of depression in adolescent with cancer. It involved 27 items self rated symptoms oriented scale suitable for individuals aged from 7-17 years, it included five factors structure that assess negative mood, interpersonal problems, ineffectiveness, anhedonia and negative self-esteem. Negative mode items (1-9), ineffectiveness items (10-14), interpersonal problems items (15-18) anhedonia items (19-22) while negative self-esteem items (23-27).
Scoring system:
The rating of this scale range from 0 (absent of depression symptoms) 1 (indicating mild depression symptoms) 2 (indicating to definite depression symptoms).
The total score range from (0-54).
Mild depression <50%.
Moderate depression 50-70%.
Severe depression >70%.
b- The Multidimensional Anxiety Scale for Children 2 (MASC2) (Appendix III):
It was adapted from March (2013), and translated into an Arabic language to assess common anxiety symptoms in children and adolescents aged 8-19 years. It’s a pediatric self report anxiety. The original scale was designed by March (1997) and revised by March (2013).The scale contains 50 item comprised of two major indexes (anxiety disorders index, inconsistency index). The scale measuring total anxiety as well as subscale on physical or somatic symptoms harms avoidance, social anxiety, generalized anxiety and separation anxiety. Separation anxiety items (1-9), generalized anxiety items (10-19), social anxiety items (20-28), obsessive compulsive and physical symptoms items (29-38) and harm avoidance items (39-50).
Scoring system:
The rating of this scale range from 0(never) 1(rarely) 2(some times) 3(usually).
Mild anxiety <50%
Moderate anxiety 50-70%
Severe anxiety >70%
c- Social interaction with others (Appendix IV):
It was developed by the researcher based on Baron )2009) and reviewed by the supervisors, it consists of 27 questions, answered by yes or no to assess social interaction of adolescent with others.
Scoring system:
Each question answered yes was scored as zero and one mark to question answered no. The total scored was collected and accordingly to the answers of adolescents interaction was clarified as ≥ 60% interacted, < 60% non-interacted.
2-Operational design:
The operational design includes preparatory phase, validity & reliability, and pilot study.
Preparatory phase:
It included reviewing of related literature and theoretical knowledge of various aspects of the study using text books, articles, periodicals, journal and web sites was done to develop the study tools and to get acquainted with the various aspects of the research problem.
Validity and reliability:
It was done based on result of pilot study and ascertained by a jury of three expertise in pediatric nursing who reviewed the tools for clarity, relevance, comprehensiveness, understandable and applicability. For reliability test was done by using Cornbrash’s Alpha test; 0.82, 0.87, 0.78 and 0.83 for tools namely physical changes, depression, anxiety and social interaction respectively.
Pilot study:
A pilot study was carried out during November 2017 involving 10% (24 adolescents with cancer and received chemo and radiotherapy) of the determined total study sample. The result of the data obtained from the pilot study helped in deleted repeated questions and there was no radical modification so, all adolescents involved in the pilot study were included of the study sample.
Field work:
The actual field work started in December 2017 and was completed by May 2018 (5 months). The researcher was available in study settings two days per week (Sunday and Tuesday) to collect data at morning shift from (9am to 2 pm). The researcher was interviewing the adolescents at morning shift and introduce herself to each adolescent and gave a complete background about the study, its aim and the expected outcomes. Tools were filled by the adolescents in the presence of the researcher to clarify any ambiguities. This was done either individually or through groups. The time consumed in answering the questionnaire ranged between 20-45minutes depending up on the adolescents condition.
3- Administrative design:
An official letter requesting permission to conduct the study was submitted from the dean of Faculty of Nursing to the director of children hospital affiliated to Ain Shams University. This letter included the aim of the study and study tools in order to get the permission and help for collection of data.
Ethical considerations:
An official permission from ethics committee affiliated to Ain Shams University to carry this study, all adolescents’ right were secured, they were informed that the given information will be used only for research purpose. The adolescents were ensured that they have the right to withdraw from study at any time without giving any reason.
4- Statistical analysis:
Data collected from the studied sample was revised, coded and entered using computer. Data entry and statistical analysis was achieved using statistical package for social sciences (SPSS) version 20, data was presented using Qualitative statistics in the form of frequencies, percentages, mean,standared deviation, chi-square test (x2) was used in order to compare proportions between the qualitative variables and Fisher’s exact test: was used to examine the relationship between two qualitative variables when the expected count is less than 5 in more than 20% of cells and Spearman correlation analysis was used for assessment of the inter-relationships among quantitative variables.
The confidence interval was set to 95% and the margin of error accepted was set to 5%.
Level of significance was accepted at P value:
o P-value ≤ 0.05 was considered significant.
o P-value < 0.00l was considered as highly significant.
Results:
Findings of the current study can be summarized as the following:
- Less than two thirds (64.2%) of the studied adolescents were in the age group 12-<15 years with mean age 13.73±4.67 years and half (50%) of them were female. The same table reveals that 41.7% and 73.3% of the studied adolescents were in preparatory education and from urban areas respectively.
- More than half (52.5%) of the studied adolescents were diagnosed as leukemia, and the majority (84.6%) of them was received chemotherapy. The same table represents that 68.3% and 69.2% of the studied adolescents duration of treatment 1-2 years and had not scare from previous operations respectively.
- Most (85.8% & 76.3%) of the studied adolescents had chest pain and difficulty or shortness of breath respectively. Also, 83.3% and 83.3% of the studied adolescents had loss of appetite& sick. In addition to 80.0% and 83.3% of the studied adolescents had weak in the hand or foot and had joints pain respectively.
- The majority (94.2%) of the studied adolescents had fall hair. Also 71.3% and 72.9% of the studied adolescents had changed skin color and loss of weight respectively.
- Slightly more than half (51.3%) of the studied adolescents had low physical changes related to chemo and radio therapy while 20.8% of them had high physical changes.
- Less than two thirds (64.2%) of the studied adolescents had moderate depression, While 20.8% and 15% of them had mild and severe depression respectively.
- Half (50.4%) of the studied adolescents had mild anxiety level, While 37.9% and 11.7% of them had moderate and severe anxiety level respectively.
- More than half (68.8%)non-interacting with other and (31.2%)interacting with others
- There were statistical significant differences between levels of depression of the studied adolescents and their age, educational stage, ranking and residence, while, there was no statistical significant differences between studied adolescents gender and their level of depression.
- There were statistical significant differences between level of depression of the studied adolescents and their type treatment receiving which duration of treatment. While, there was no statistical significant differences between studied adolescents, diagnosis and previous surgical operations.
- There were statistical significant differences between level of anxiety of the studied adolescents and their age, educational stage, ranking and residence. While, there was no statistical significant differences between studied adolescents, gender and their level of anxiety.
- There were statistical significant differences between level of anxiety of the studied adolescents and their diagnosis and duration of treatment. While there was no statistical significant differences between studied adolescents, Type of treatment received and previous surgical operations
- There were statistical significant differences between physical changes of the studied adolescents and their age, gender, educational stage and ranking. While there was no statistical significant differences between studied adolescents, residence.
- There were statistical significant differences between physical changes of the studied adolescents and their diagnosis, Type of treatment received, duration of treatment and previous surgical operations.
- There were statistical significant differences between social interactions of the studied adolescents age. While, while there was no statistical significant differences between studied adolescents, gender, educational stage, ranking and residence.
- There were no statistical significant differences between studied adolescents, diagnosis, Type of treatment received and duration of treatment. While statistically significant differences studied adolescents previous surgical operations and social interaction.
- Highly statistical significant difference between studied adolescents physical changes and their social interaction with others, depression level and anxiety level.
- Statistical significant differences between social interaction and their level of depression and anxiety.
Conclusion:
Based on the results of the present study and research questions, the study concluded that:
More than half of the studied adolescents had low changes and the minority of them had high physical changes related to chemo and radiotherapy. In addition, the physical changes of adolescents affect their psychosocial status in front of anxiety and depression. Moreover, there were statistical significance difference between studied adolescents’ physical changes and their psychosocial status regarding to social interaction, depression and anxiety level.
Recommendations
In the light findings of the present study, the following recommendations are suggested:
- Provide health education session to adolescents with cancer about how dealing with side effect of cancer treatment.
- Encourage group therapy to decrease fear, depression and anxiety for adolescents and to improve self image.
- Developing an educational program for adolescents with cancer regarding care of side effect of cancer treatment.
- Periodic asses of physical changes due to chemo and radiotherapy.
- Support and educate adolescents suffering from cancer to prevent and manage complications related to chemo and radiotherapy.
- Monitoring psycho social impact of chemo and radiotherapy of cancer adolescents with cancer.