Running head: INTEGRATIVE REVIEW 1

Integrative Review

Angela Ofori

Bon Secours Memorial College of Nursing

Arlene Holowaychuk MSN, RN

4122 Nursing Research

October 24, 2017

I pledge
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Abstract

The purpose of this integrative review is to appraise literature pertaining to the perspective of

adolescents with cancer on their quality of life during or after their treatment. An adolescent is

going through many phases during the stage of adolescence adding cancer to the lives of these

children can influence their lifestyle and psychological needs. There were five articles that were

used for this review pertaining to the topic. There were two search engines that were utilized to

conduct this review were EBSCO Discovery Services and Google Scholar. The results of these

five articles demonstrated that adolescents with cancer viewed the quality of life during or after

as diminished. Limitations of this review included that the that the researcher is a nursing student

that has limited research experience and there is a limited number of articles. Additional research

should focus on the appropriate psychological interventions for adolescents with cancer and how

they view their quality of life following the interventions.

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Integrative Review

The purpose of this integrative review is to search the literature pertaining to adolescents

with cancer perspective on the quality of life during or after treatment. The adolescence stage is a

difficult because of the transitions that made throughout the physical, mental, and emotional

aspects of life. Cancer is a disease that affects anyone no matter the stage of life they are

diagnosed and or treated. The impact of cancer during an adolescent’s life can cause a matter of

different psychosocial experiences that would affect their daily life and interactions. Adolescents

are at the period at their life where they are searching for their personal identity, emotions,

relationships, autonomy, opportunities in the future, and maturity (Khan, Arora, Chakravarty, &

George, 2012). The PICOT question that was analyzed for the use of this integrative review, how

do adolescents with cancer perceive their quality of life during or after treatment? The age range

for adolescent is 12- 18 years old. The research that was done will improve ways to help this

population during and or after cancer treatment.

Research Design & Search Methods

The research design is an integrative review. The search engines that were used to search

for the articles relevant to the PICOT question were EBSCO Discovery Services and Google

Scholar. The keywords that were used during the search were, ‘quality of life’, ‘adolescents with

cancer’, ‘wellbeing’, and ‘psychosocial’. EBSCO Discovery Services yielded 328 articles and

Google Scholar yielded 32,000 articles.

The search was narrowed down to peer-reviewed and qualitative articles that pertain to

the PICOT question. The academic journals had to be published in English with full text by

credible authors. During the search of the articles, it was pertinent to have articles that were

published from 2012 to 2017 for relevance. The articles that were excluded from the review did
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not meet criteria. The articles that included in this review are five qualitative studies that are

relevant to the PICOT question.

Findings/Results

The findings and results of the five reviewed studies identify that the participants do have

similar perceptions on their quality of life during or after cancer treatment (Al Omari &

Wynaden, 2014; Götte, Kesting, Winter, Rosenbaum, & Boos 2014; Khan, Arora, Chakravarty,

& George, 2012; Macartney, Stacey, Harrison, & VanDenKerkhof, 2014; Stinson et al., 2015).

The review is structured around two themes: psychological physical distress.

Psychological Distress

Four out of the five qualitative studies discussed the theme of psychological distress

caused by cancer and the treatment. Relationships, school, and social stigma were a consensus of

the four out of five studies (Al Omari & Wynaden, 2014; Khan, Arora, Chakravarty, & George,

2012; Macartney, Stacey, Harrison, & VanDenKerkhof, 2014; Stinson et al.,2015). The study

conducted by Khan et al., (2012), had a sample size of seven adolescents from India, semi-

structured interviews were conducted by the researcher for data collection.

Four out of the seven the participants discussed their frustrations with missing school due

to falling ill due to the cancer treatment. The participants of this study discussed the social

stigma that they endured one of the participants stated: “his paternal uncle behaved very

differently after illness, he didn’t let his children come close to my child because he had cancer”

(Khan et al.). The adolescents of this study felt about the place and did felt hopeless. Similar

findings were found in regards to the social stigma that these adolescents are dealt with because

of their diagnosis.
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The study conducted by Al Omari & Wynaden (2014), explores the experiences of 14

Jordanian adolescents with hematological malignancies that were hematological cancer

diagnoses. The data was collected by conducting interviews. Similar to the study that was

conducted by Khan et al. (2012), the participants discussed how they felt having cancer and the

social stigma that comes along with it. The participants had a consensus that they did not feel

comfortable talking about cancer, and the fact that they would be called names as well the looks

that came along with having cancer. The participants also feared the unknown based on the lack

information that was provided to them such if the treatment would be effective for them, what

necessary procedures that would need to be done. The adolescents feared to know that it was

possible they could die.

Stinson et al. (2015), examined 20 adolescents with cancer and their perspectives of

relationships and fertility, interviews were conducted to collect information, transcribed and

coded. The majority of the participants believed that dating or relationships with others were a

good moral support during their time of the diagnosis. Since their cancer diagnosis did not feel

some of the participants felt that it was not pertinent to start or be dating whilst receiving

treatment. The article conducted by McCartney et al.(2014), the participants felt that having

friendships were pertinent relationships during the journey of treatment. The summary of this

research article is located in Table 4. Cancer and the treatment had played a huge role in the way

that adolescents viewed aspects of their life psychologically and psychosocially.

Physical Distress

Three out of the five articles discussed the common theme of physical distress endured by

the participants because of cancer and also the treatment. It is discussed how the adolescents felt

about the loss of their hair, weight loss or weight gain, and fatigue that would occur ( Götte,
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Kesting, Winter, Rosenbaum, & Boos 2014; Khan, Arora, Chakravarty, & George, 2012;

Macartney, Stacey, Harrison, & VanDenKerkhof, 2014). The study that was conducted by

Macartney et al. (2014) examined of quality for life of 12 brain tumor adolescent survivors in

Ontario Canada by conducting interviews. In the article, the five of the survivors stated they

experienced physical problems such as loss of vision, hearing, muscle strength, problems with

equilibrium which were a result of cancer treatment (Macartney et al.).

An article reviews the perspectives of the participants and the physical debilitations that

are endured on the daily basis such fatigue, pain, certain restrictions such as food, and

overcrowded areas (Khan et al., 2012). The participants of the study felt that they are losing part

of their life due to the change in lifestyle because of cancer. Summary of the article located in

Table 3.

The research conducted by Götte et al. (2014), the physical limitations that the

adolescents have due to the side effects of treatment including nausea, fatigue, pain, and gastric

problems. Götte et al. (2014), had a sample size of 40 participants, face to face interview was

done, and the data was transcribed verbatim. A participant had been exhausted from running

once or twice and was not able to complete the physical activity because he was short of breath

and begun to feel tired (Götte et al., 2014).

Discussion/Implications

The findings and results of the five research articles in the review identified that

adolescents with cancer had similar perspectives of their quality of life during or after cancer

treatment. The articles support the PICOT question. The importance of the qualitative articles in

relation to the PICOT question is necessary to provide the healthcare professional the perspective

of adolescents with cancer the how they view their life during or after cancer treatment. The
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participants overall had similar perspectives of their quality of life but some of the topics had a

consensus that cancer had an impact on their daily life. Most of the participants of the research

articles all experienced the loss of autonomy, relationships, and growth and independence which

is part of being an adolescent.

Cancer is a disease that causes an effect on just the physical but the psychosocial aspects

of an individual. Healthcare providers can implement skills or techniques to improve the quality

of life and experience those adolescents with cancer. Continuing to prepare the adolescents and

their family for the effects that the cancer treatment can influence the way that they feel.

Continuing to research will help nurses and physicians identify the psychological symptoms and

optimize the symptom management to enhance the quality of life for these patients (Macartney et

al., 2014). The research will continue to inform healthcare professionals’ different forms of

implementing future interventions into practice (Stinson et al., 2014).

Limitations/Conclusions

There were limitations that were recovered during this research that will be discussed in

this integrative review. The researcher of this integrative review has limited experience

completing an integrative review. There amount of articles is limited to five and the articles had

to be less than five years old. The sample size most of the articles were adequate for a qualitative

study. All of the studies used interviewing to collect data from the participants. There was

difficulty searching for articles pertaining to this topic. One of the research articles included only

male participants. The group of participants all came from one hospital so the findings cannot be

generalized to pediatric patient population (Götte et al.,2014). Three out of the five articles

limitations included that parents may have influenced that way that the adolescent participants
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answered their interview questions (Al Omari & Wynaden, 2014; Götte, Kesting, Winter,

Rosenbaum, & Boos 2014; Stinson et al., 2015).

The findings of this integrative review highlight the perspective of adolescents with

cancer and what they go through and how they feel during their journey of cancer treatment

during or after. The evidence from the research supports the PICOT question in regards to how

adolescents with cancer perceive their quality of life during or after treatment?

The five studies concluded that adolescents with cancer no matter where they come from having

similar perspectives on their quality of life during or after treatment which would be a poor. A

majority of the participants of the studies that were included in this integrative review have lost

their sense of autonomy, independence, relationships, maturity, and future life opportunities

because their life has come to a halt in order to treat cancer. Cancer has its own effects adding

treatment whether it surgical, chemotherapy, and or radiation can cause trauma to an individual

especially an adolescent who is still developing mentally, emotionally, physically, and

spiritually. The study should improve the way that healthcare professionals teach and discuss the

effects of cancer treatment physically and psychologically. Preparing the adolescents and parents

and or family is the best practice as well as also being able to support the adolescents and parents

and or family during this journey is extremely pertinent

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References

Al Omari, O., & Wynaden, D. (2014). The psychosocial experience of adolescents with haematological

malignancies in Jordan: An interpretive phenomenological analysis study. The Scientific World

Journal, 2014.

Götte, M., Kesting, S., Winter, C., Rosenbaum, D., & Boos, J. (2014). Experience of barriers and

motivations for physical activities and exercise during treatment of pediatric patients with

cancer. Pediatric Blood & Cancer, 61(9), 1632-1637. doi:10.1002/pbc.25071

Khan, F., Arora, S., Chakravarty, S., & George, S. (2012). A qualitative study to explore the experiences

of adolescents living with cancer. International Journal of Nursing Education, 4(2).

Macartney, G., Stacey, D., Harrison, M. B., & VanDenKerkhof, E. (2014). Symptoms, coping, and

quality of life in pediatric brain tumor survivors: a qualitative study. Oncology Nursing Forum,

41(4), 390-398. doi:10.1188/14.ONF.390-398

Stinson, J. N., Jibb, L. A., Greenberg, M., Barrera, M., Luca, S., White, M. E., & Gupta, A. (2015). A

Qualitative study of the impact of cancer on romantic relationships, sexual relationships, and

fertility: perspectives of canadian adolescents and parents during and after treatment. Journal Of

Adolescent & Young Adult Oncology, 4(2), 84-90. doi:10.1089/jayao.2014.0036

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Table 1 Al Al Al Omari, O., & Wynaden, D. (2014). The psychosocial experience of

Reference (APA) adolescents with haematological malignancies in Jordan: An interpretive

phenomenological analysis study. The Scientific World Journal, 2014.

Author Omar Al Omari – Children and Young People’s Mental Health, Faculty of
(Year)/Qualifications Nursing, Jerash University

Dianne Wynaden – School of Nursing and Midwifery

2014

Introduction/ Gaining the perspective of Jordanian adolescents with hematological

Background/Problem malignancies.
Statement The adolescents have hematological cancer causing physical and
psychological distress to the adolescents.

Conceptual/ Theoretical Framework was not discussed

Theoretical
Framework

Design/Research Qualitative
Methods/Sample/ Phenomenological analysis
Setting/Ethical Interview twice during the first six months after diagnosis
Considerations/ Sample Size=14
Major Variable Ethical approval was obtained from one university and two hospitals ethics
Studied/ committees
Measurement The data was transcribed verbatim by the researcher and reviewed for
Tool/Data Collection accuracy
Tool/Data Analysis Jordanian Adolescents with hematological malignancies
The data was managed using QSR NVivo8 software
The data analysis was conducted using the method of IPA

Findings/Results There were three themes that were emerged: Being in Hospital, Changing
Self, and Fearing the Unknown.
The participants discussed the factors that played a role in the experiences that
they had.

Discussion/ The impact of hospitalization was discussed by the adolescents. The effects of
Implications cancer were also discussed.
The educational needs were discussed as well.
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Limitations/ The limitations were that the sample size is small and participants’ parents
Conclusions were present during the study and may have impacted the data.
The article details the lived experiences of Jordanian adolescents with
hematological malignancies. The participants discussed the negative
experiences that they have had since their diagnosis.

Appraisal/Worth to Yes, there will be follow up studies; and the the study will help continue to
practice impact the quality of nursing.
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Table 2 Götte, M., Kesting, S., Winter, C., Rosenbaum, D., & Boos, J. (2014). Experience
of barriers and motivations for physical activities and exercise during treatment of
Reference (APA) pediatric patients with cancer. Pediatric Blood & Cancer, 61(9), 1632-1637.
doi:10.1002/pbc.25071

Author Miriam Gotte, DIPL;Sabine Kesting, MA; Corinna Winter, PhD; Dieter
(Year)/Qualifications Rosenbaum, PhD;
& Joachim Boos MD (2014)

Introduction/ Cancer patients suffer from anxiety, depression, and stress due to the diagnosis
Background/Problem which affects the quality of life leading to physical inactivity. The study will
Statement explore the children and adolescents with cancer and the affect that physical
activity has on the mind and body. The study will gain the perspective of of
children and adolescents with cancer and the effects of physical activity during
treatment.

Conceptual/ None was discussed

Theoretical
Framework

Design/Research Cross-sectional qualitative study

Methods/Sample/ Face to face interview
Setting/Ethical 40 participants
Considerations/ Interviews were recorded and transcribed verbatim
Major Variable Local ethics committee approved; legal guardians and patients gave a written
Studied/ consent
Measurement MAXDA, version 11, VERBI GmbH was the software that was used
Tool/Data Collection
Tool/Data Analysis

Findings/Results There were values and beliefs that were identified; the participants considered that
physical activity is beneficial during cancer treatment.
Barriers and m motivations were identified from the study that would affect
whether or not the participants were willing to participate in a physical activity.

Discussion/ The participants participated in the local exercise program; the had a positive
Implications attitude toward the program.
It was discovered that physicians had not been implementing physical activity and
exercise to their patients. It is important that physician recommend physical
activity to the patients this would improve the state of mind and body to the
patients.

Limitations/ Limitations
Conclusions - The patients were recruited from one hospital.
- Influence from the interviewers in the exercise program
- The opinions from the physicians and parents
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Conclusion
The participants felt that some sort of physical activity will benefit them,
there are also barriers that would affect whenever they will be performing a
physical activity.

Appraisal/Worth to Yes, it will improve nursing care

practice
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Table 3 Khan, F., Arora, S., Chakravarty, S., & George, S. (2012). A qualitative study to explore

Reference (APA) the experiences of adolescents living with cancer. International Journal of

Nursing Education, 4(2).

Author Khan, Fareha Khan MSc Nursing Student, Smriti Arora Assistant Professor, Sujana
(Year)/Qualifications
Chakravarty Principal Faculty of Nursing, & Sunil George Assistant Professor,

Indian Institute of Public Health (2012)

Introduction/ The fact that adolescents and young adults are very likely to get diagnosed with
Background/Problem than children under 15.
Statement

Conceptual/ Not discussed

Theoretical
Framework

Design/Research Qualitative
Methods/Sample/ Semi-Structured interviews; interviews lasted 45-90 minutes
Setting/Ethical The interviews took place from Nov. 2011 to Jan. 2012
Considerations/ Indian adolescents
Major Variable Sample size 7
Studied/ Data was transcribed and field
Measurement Ethics committee of Jamia Hamdard
Tool/Data Collection
Tool/Data Analysis

Findings/Results The researchers found most of adolescents the missing school was definitely a
problem for them. Most of the adolescents said that there family were very
supportive during this time.

Discussion/ The adolescents discuss living experiences with cancer and treatment and the
Implications social stigma that comes with it as well as the physical and psychosocial effects
that it has caused.
This study will provide nurses with an idea of what needs to be implemented into
teaching the adolescents and their family what would be expected.

Limitations/ Some of the limitations were that males were the only participants included in this
study.
Conclusions Cancer can be destruct the way that people look and feel about themselves. It is
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important for nurses to support their patients holistically to improve quality care.

Appraisal/Worth to Yes, it is worth the practice it will provide nurses a perspective on what patients

practice are going through in this population

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Table 4 Macartney, G., Stacey, D., Harrison, M. B., & VanDenKerkhof, E. (2014).
Symptoms, coping, and quality of life in pediatric brain tumor survivors: a
Reference (APA) qualitative study. Oncology Nursing Forum, 41(4), 390-398.
doi:10.1188/14.ONF.390-398

Author Gail Macartney, RN(EC), PhD, CON(C); Dawn Stacey, RN, PhD, CON(C);
(Year)/Qualifications Margaret B. Harrison, RN, PhD; &Elizabeth VanDenKerkhof, RN, DrPH (2014)

Introduction/ Explore experiences that the patients have and how it affects their quality of life.
Background/Problem Survivorship can also complicate the quality of life due to the deprivation a good
Statement quality of life during treatment.
The affects of a patient going under treatment for a brain tumor cause
neurological and cognitive deficits that will affect the activity of daily living.

Conceptual/ Researchers want to know how symptoms impact the quality of life for children
Theoretical who had received treatment for a brain tumor.
Framework

Design/Research Qualitative Study

Methods/Sample/ Semistructured interviews
Setting/Ethical Descriptive methodology
Considerations/ Hospital in Ontario, Canada
Major Variable 12 children age range of 9-18 years old
Studied/ Written consent was obtained prior to study ; Queen’s University Research
Measurement Ethics Board & Hospital’s Research Ethics Board
Tool/Data Collection
Tool/Data Analysis

Findings/Results - Based on the survey the symptoms that children were experiencing
varied which included: feeling tired, pain, headaches emotional
symptoms, cognition problems, difficult sleeping, physical problems, and
or changes in weight.
- Fatigue was a common symptom most of the participants(7); feeling
drowsy, having less energy especially during the end of school.
- The pain that was experienced were headaches very common, extremity
pain due to physical exertion. Headaches were exacerbated by dizziness
and fatigue.
- Emotional problems were described as anger, stress, worry, nervousness,
sadness, and irritability.
- Difficulty thinking, remembering, focusing, doing schoolwork, or paying
attention in class were descriptions from six of the participants.
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The children have coping strategies to deal with their symptoms such as
volunteering, keeping up with family, friends, laughing, using aids, and
challenging themselves.

Discussion/ The children appear to be experiencing post traumatic growth which is a positive
Implications change that is experienced after a struggle with a traumatic experience. The
participants experience cancer and the treatment and are dealing with the
aftermath of the treatment but have a different outlook on life due to their
experience.

Limitations/ Transferability was limited due to the single institution study

Conclusions There was a interview done prior to explore the symptoms that they had; some of
the participants were less inclined to discuss other symptoms that were affecting
them.

The participants suffer from multiple symptoms which affect their lives daily.
11 of the participants overall felt that had a good quality of life after the
treatment due to different coping therapies that are used to relieve their
symptoms.

Appraisal/Worth to Coping strategies can improve the way that children may think of their
practice experience.
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Table 5 Stinson, J. N., Jibb, L. A., Greenberg, M., Barrera, M., Luca, S., White, M. E., &
Gupta, A. (2015). A Qualitative study of the impact of cancer on romantic
Reference (APA) relationships, sexual relationships, and fertility: perspectives of canadian adolescents
and parents during and after treatment. Journal Of Adolescent & Young Adult
Oncology, 4(2), 84-90. doi:10.1089/jayao.2014.0036

Author Jennifer N. Stinson, RN-EC, PhD; Lindsay A. Jibb, RN, MSc; Mark Greenberg, MB,
(Year)/Qualificat ChB; Maru Barrera, PhD; Stephanie Luca, MA,; Meghan E. White, BA, & Abha Gupta,
ions MD, MSc (2014)

Introduction/ The perspectives of sexual relationships, romantic relationships, and fertility on

Background/Pro adolescents (12-17 years old) and parents.
blem Statement

Conceptual/ Not Discussed in the article

Theoretical
Framework

Design/Research Qualitative Study

Methods/Sample/ Phenomenology
Setting/Ethical The researchers gathered a variety of participants: gender, type of cancer, and a range
Considerations/ of adolescent ages.
Major Variable Sample size was identified as 20 adolescents with cancer and 20 parents in Canada.
Studied/ Research Ethics Board approved of the study
Measurement Data collection was obtained from interviews that were audio recorded and transcribed
Tool/Data verbatim by the researchers.
Collection Demographic characteristics were calculated by SPSS version 2
Tool/Data
Analysis

Findings/Results The study found themes that were related to the relationships that adolescents had or
lack of during treatment or after receiving treatment.
Results showed adolescents felt that dating was a good form of support during cancer
treatment
Participants of this study had different perspectives in regards to the impact that cancer
has on the relationship aspect.
There were similarities and differences identified with the study.

Discussion/ Fertility was a concern among the participants especially the female population
Implications limited interaction in regards of sexual, romantic relationships, and fertility

Limitations/ Some of the adolescents had limited experience in dating and had a lack of knowledge
Conclusions regarding fertility.

Appraisal/Worth Interventions or teachings are appropriate for the adolescents and parents regarding the
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to practice impact that cancer has to the psychosocial aspect.