Ka Yan Ho

The impact of cancer on the physical, psychological and social well-being of childhood cancer survivors

PURPOSE Notwithstanding the advances in medical treatment, childhood cancer survivors are at risk of adverse physical, psychological and social effects of the cancer treatment. The purpose of this study was to examine the impact of cancer and its treatments on the physical, psychological and social well-being of Hong Kong Chinese childhood cancer survivors. METHOD A total of 137 childhood cancer survivors (aged 9-16 years), who had their medical follow-up in an oncology out-patient clinic were invited to participate in the study. Participants were asked to respond to the standardized measures of depressive symptoms and self-esteem. Additionally, 15 participants from the group were selected for a semi-structured interview. RESULTS The results revealed that more than half of the participants presented depressive symptoms. Results also found that the mean depressive symptom scores for childhood cancer survivors were statistically significant higher than those of school children without cancer (p = 0.01), while the mean self-esteem scores for the survivors were statistically significant lower (p < 0.01). Additionally, qualitative interviews indicated that cancer and its treatments have great impact on the daily life of childhood cancer survivors. CONCLUSION The study reveals that cancer and its treatments have a great impact on the physical, psychological and social well-being of survivors. It is essential for healthcare professionals to develop appropriate interventions with the aim of promoting physical, psychological and social well-being for these children. Most importantly, it is crucial to help them develop a positive view of the impact that the cancer experience has upon their lives.

Play interventions to reduce anxiety and negative emotions in hospitalized children

BackgroundHospitalization is a stressful and threatening experience, which can be emotionally devastating to children. Hospital play interventions have been widely used to prepare children for invasive medical procedures and hospitalization. Nevertheless, there is an imperative need for rigorous empirical scrutiny of the effectiveness of hospital play interventions, in particular, using play activities to ease the psychological burden of hospitalized children. This study tested the effectiveness of play interventions to reduce anxiety and negative emotions in hospitalized children.MethodsA non-equivalent control group pre-test and post-test, between subjects design was conducted in the two largest acute-care public hospitals in Hong Kong. A total of 304 Chinese children (ages 3-12) admitted for treatments in these two hospitals were invited to participate in the study. Of the 304 paediatric patients, 154 received hospital play interventions and 150 received usual care.ResultsChildren who received the hospital play interventions exhibited fewer negative emotions and experienced lower levels of anxiety than those children who received usual care.ConclusionThis study addressed a gap in the literature by providing empirical evidence to support the effectiveness of play interventions in reducing anxiety and negative emotions in hospitalized children. Findings from this study emphasize the significance of incorporating hospital play interventions to provide holistic and quality care to ease the psychological burden of hospitalized children.Trial registrationClinicalTrials.gov NCT02665403. Registered 22 January 2016.

The Effect of Poverty and Income Disparity on the Psychological Well-Being of Hong Kong Children

OBJECTIVE This study explored the impact of poverty and income disparity on the psychological well-being of Hong Kong Chinese children. DESIGN AND SAMPLE A cross-sectional study was conducted in 12 elementary schools from the three highest and three lowest median household income districts. A total of 1,725 pupils were recruited with 898 pupils came from low-income and 827 from high-income families. MEASURES Participants were asked to respond to the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children, the Rosenberg self-esteem scale, and the Pediatric Quality of Life Inventory. The data were collected from 2012 to 2013. RESULTS Children from low-income families reported statistically significant lower scores in self-esteem and quality of life, but higher scores in depressive symptoms than those from high-income families. Income disparity had their greatest impact on childrens self-esteem. CONCLUSION This study has addressed a gap in the literature by comparing the self-esteem, depressive symptoms, and quality of life among children living in low- and high-income families. The results add further evidence to the literature that poverty and income disparity may have a negative impact on the psychological well-being of children.

Sustainability of an Integrated Adventure-Based Training and Health Education Program to Enhance Quality of Life Among Chinese Childhood Cancer Survivors: A Randomized Controlled Trial.

Background: Physical activity is of paramount importance to enhance the quality of life of childhood cancer survivors. Objective: The objectives of this study were to examine the sustainability, feasibility, and acceptability of an adventure-based training and health education program in changing the exercise behavior and enhancing the physical activity levels, self-efficacy, and quality of life of childhood cancer survivors. Methods: A follow-up study (12 and 18 months) of a previous study was conducted. Participants in the experimental group (n = 33) joined a 4-day integrated adventure-based training and health education program. The control group (n = 36) received the standard medical care. Changes in exercise behavior, levels of physical activity, self-efficacy, and quality of life were assessed from the time of recruitment, and at 12 and 18 months after starting the intervention. Process evaluation was conducted to determine whether the program was feasible and acceptable to participants. Results: From baseline to 18 months after the intervention, the experimental group reported statistically significant differences in the stages of change in physical activity and higher levels of physical activity, self-efficacy, and quality of life than did the control group. The results of process evaluation revealed that the program was both feasible and acceptable to participants. Conclusions: The program was found to have substantial effects on enhancing the physical activity levels, self-efficacy, and quality of life of childhood cancer survivors over at least 18 months. Implications for Practice: Healthcare professionals should consider adopting such programs to promote the regular physical activity among childhood cancer survivors.

Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial.

The aim of the study was to examine the effects of a brief stage-matched smoking cessation intervention group compared with a control group (with usual care) in type 2 diabetes mellitus patients who smoked by randomized controlled trial. There were 557 patients, randomized either into the intervention group (n = 283) who received brief (20- minute) individualized face-to-face counseling by trained nurses and a diabetes mellitus-specific leaflet, or a control group (n = 274) who received standard care. Patient follow-ups were at 1 week, 1 month, 3 months, 6 months, and 12 months via telephone, and assessment of smoking status from 2012 to 2014. Patients smoked an average of 14 cigarettes per day for more than 37 years, and more than 70% were in the precontemplation stage of quitting. The primary outcome showed that both the intervention and control groups had similar 7-day point-prevalence smoking abstinence (9.2% vs. 13.9%; p = 0.08). The secondary outcome showed that HbA1c levels with 7.95% [63 mmol/mol] vs. 8.05% [64 mmol/mol], p = 0.49 at 12 months, respectively. There was no evidence for effectiveness in promoting the brief stage-matched smoking cessation or improving glycemic control in smokers with type 2 diabetes mellitus, particularly those in the pre-contemplation stage.

The Psychometric Properties of the Chinese Version of the Fatigue Scale for Children.

Background: The availability of a valid and reliable instrument that accurately assesses the level of fatigue among childhood cancer survivors is a prerequisite for developing and evaluating interventions designed to reduce fatigue. There is a lack of such an instrument for use in the Hong Kong Chinese context. Objective: The aim of the study was to examine the psychometric properties of the Chinese version of the Fatigue Scale for Children. In particular, confirmatory factor analysis was conducted to examine its factorial structure. Methods: A convenience sample of 200 Hong Kong Chinese children surviving cancer was recruited in an outpatient clinic. The psychometric properties of the Chinese version of the Fatigue Scale for Children were assessed. Results: The content validity index was 0.83. There was a strong positive correlation between children’s level of fatigue and depressive symptoms (r = 0.53) and a strong negative correlation between children’s levels of fatigue and quality of life (r = −0.54). The mean levels of fatigue of the survivor group were significantly lower than those of those hospitalized with cancer, but significantly higher than those of their healthy counterparts. Confirmatory factor analysis indicated that there were 3 factors underlying the Chinese version of the Fatigue Scale for Children. Conclusion: The study adds further evidence that the Chinese version of the Fatigue Scale for Children can be used as a reliable and valid tool in assessing cancer-related fatigue among Chinese children who have survived cancer. Implications for Practice: The translated scale can be used to develop and evaluate appropriate fatigue reduction interventions.

Efficacy of Musical Training on Psychological Outcomes and Quality of Life in Chinese Pediatric Brain Tumor Survivors

Evidence has shown that survivors of pediatric brain tumors have more negative psychological sequela, particularly depression, than do survivors of other childhood cancers. This study examined the efficacy of a musical training program in reducing depressive symptoms and enhancing self‐esteem and quality of life in Hong Kong Chinese pediatric brain tumor survivors.

Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: A phase 2 randomized controlled trial

OBJECTIVES To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic. METHODS A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone. The intention-to-treat principle was used. RESULTS At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). CONCLUSION These data suggest that quitting immediately might be more effective than cutting down to quit at 6 months but not at 12 months. PRACTICE IMPLICATIONS It is crucial to allow smokers to select quitting immediately or reducing the number of cigarettes smoked. Further studies are warranted to compare the effectiveness of various approaches for achieving smoking abstinence.

Exploratory study on the relationship between smoking and other risk behaviours among young smokers

AIMS AND OBJECTIVES To explore the relationship between smoking and other risk behaviours among Chinese young people in Hong Kong. BACKGROUND There is growing concern about coexisting risk behaviours in young smokers. Information about smoking and other risk behaviours is crucial for developing interventions to promote smoking abstinence and adoption of healthy lifestyles. The relationship between smoking and other risk behaviours among Chinese young people in Hong Kong has not been explored. DESIGN This is a mixed-method retrospective population-based study. METHODS A retrospective population-based study was conducted with 1,147 young smokers through Youth Quitline between November 2011-July 2016. Attitudes, behaviours and experiences related to smoking and risk behaviours among Chinese young smokers were examined in semi-structured qualitative interviews with 30 participants randomly selected from the retrospective population-based study. RESULTS In total, 45.5% participants reported engaging in at least one other risk behaviour. The interviews revealed that drinking alcohol may have a significant impact on quitting smoking. In addition, smoking may be a gateway for more serious risk behaviours during adolescence. Low health awareness may explain the unhealthy lifestyles among young smokers. CONCLUSIONS This study bridges a gap in existing literature by exploring relationships between smoking and other risk behaviours among young people in Hong Kong. RELEVANCE TO CLINICAL PRACTICE Given the interrelationships between smoking and other risk behaviours, a holistic approach should be used to promote smoking cessation and healthy lifestyles among young smokers. If young smokers improve their health and quit smoking at the same time, their physical and mental development will benefit as a secondary outcome.

Change in symptom clusters in head and neck cancer patients undergoing postoperative radiotherapy: A longitudinal study

PURPOSE Research on symptom clusters is a newly emerging field in oncology; however, little evidence regarding symptom clusters in head and neck cancer (HNC) is currently available. To clarify this under-researched area, we investigated symptom clusters among patients with HNC treated with surgery and postoperative radiotherapy. We also examined the pattern of symptom clusters throughout the treatment course. METHOD A convenience sample of 100 patients with HNC was recruited in the Ear, Nose, and Throat unit of a medical center in Taiwan. Before undergoing postoperative radiotherapy, patients were asked to complete the MD Anderson Symptom Inventory and a demographic sheet. Patients completed the same inventory questionnaire at week 1, 2, 3, 4, 5, and 6 of radiotherapy. RESULT Two symptom clusters were observed, and they were stable throughout the course of radiotherapy. Cluster 1, the HNC-specific cluster, comprised the symptoms of pain, dry mouth, lack of appetite, sleep disturbance, fatigue, drowsiness, distress, and sadness. Cluster 2, the gastrointestinal cluster, included nausea, vomiting, numbness, shortness of breath, and difficulty remembering. CONCLUSION This study advanced our knowledge of symptom clusters in patients with HNC. The results are expected to contribute to the development of appropriate assessment and nursing interventions targeting multiple symptoms that may coexist in postoperative radiotherapy.