Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Seattle Children's Hospital, Seattle, Washington, USA.
Pediatr Blood Cancer. 2023 May;70(5):e30277. doi: 10.1002/pbc.30277. Epub 2023 Mar 7.
Survivorship education and anticipatory guidance represent an unmet need for pediatric, adolescent, and young adult (AYA) cancer survivors and their caregivers when treatment ends. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of a structured transition program, bridging treatment to survivorship, to reduce distress and anxiety and increase perceived preparedness for survivors and caregivers.
Bridge to Next Steps is a two-visit program, within 8 weeks prior to treatment completion and 7 months post treatment, which provides survivorship education, psychosocial screening, and resources. Fifty survivors (age range 1-23 years) and 46 caregivers participated. Participants completed pre- and post-intervention measures: Distress Thermometer and Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety/emotional distress (ages ≥8 years), and perceived preparedness survey (ages ≥14 years). AYA survivors and caregivers completed a post-intervention acceptability survey.
Most participants (77.8%) completed both visits, and most AYA survivors (57.1%) and caregivers (76.5%) endorsed the program as helpful. Caregivers' distress and anxiety scores decreased from pre to post intervention (p < .01). Survivors' scores remained the same, which were low at baseline. Survivors and caregivers felt more prepared for survivorship from pre to post intervention (p = .02, <.01, respectively).
Bridge to Next Steps was feasible and acceptable for most participants. AYA survivors and caregivers felt more prepared for survivorship care after participation. Caregivers reported decreased anxiety and distress from pre to post Bridge, whereas survivors remained at a low level for both. Effective transition programs that better prepare and support pediatric and AYA cancer survivors and families from active treatment to survivorship care can contribute to healthy adjustment.
在治疗结束时，儿科、青少年和年轻成人（AYA）癌症幸存者及其照顾者在生存教育和预期指导方面存在未满足的需求。本初步研究评估了结构过渡计划（治疗到生存的桥梁）的可行性、可接受性和初步疗效，该计划旨在减轻患者和照顾者的痛苦和焦虑，增加他们对生存的准备。
Bridge to Next Steps 是一个两访程序，在治疗完成前 8 周和治疗后 7 个月内进行，提供生存教育、心理社会筛查和资源。50 名幸存者（年龄范围 1-23 岁）和 46 名照顾者参加了该项目。参与者在干预前后完成了以下评估：痛苦温度计和患者报告的结果测量信息系统（PROMIS）焦虑/情绪困扰（年龄≥8 岁），以及感知准备度调查（年龄≥14 岁）。AYA 幸存者和照顾者完成了干预后接受度调查。
大多数参与者（77.8%）完成了两次访视，大多数 AYA 幸存者（57.1%）和照顾者（76.5%）认为该项目有帮助。照顾者的痛苦和焦虑评分从干预前到干预后都有所下降（p<0.01）。幸存者的评分保持不变，基线时评分较低。幸存者和照顾者从干预前到干预后都对生存护理更有准备（p=0.02，<0.01）。
Bridge to Next Steps 对大多数参与者来说是可行且可接受的。AYA 幸存者和照顾者在参与后对生存护理更有准备。照顾者报告说，在参与 Bridge 后，他们的焦虑和痛苦程度有所下降，而幸存者在这两个方面的评分都较低。有效的过渡计划可以更好地为儿童和 AYA 癌症幸存者及其家庭从积极治疗过渡到生存护理做好准备和支持，有助于其健康调整。
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