title: Psychological factors impacting transition from paediatric to adult care by childhood cancer survivors.
abstract: OBJECTIVE
  Childhood cancer survivors require life-long care focused on the specific late effects that may arise from their cancer and its treatment. In many centers, survivors are required to transition from follow-up care in a paediatric cancer center, to care provided in an adult care setting. The purpose of this study was to identify the psychological factors involved in this transition to adult care long-term follow-up clinics.
  
  
  METHODS
  Qualitative interviews were conducted with ten paediatric survivors still in paediatric care, as well as 28 adult survivors of whom 11 had transitioned successfully to adult care (attended three long-term follow-up (LTFU) appointments consecutively); ten who failed to transition (attended at least one LTFU appointment as an adult, but were inconsistent with subsequent attendance); and seven who had never transitioned (did not attend any LTFU care as an adult). Line-by-line coding was used to establish categories and themes. Constant comparison was used to examine relationships within and across codes and categories.
  
  
  RESULTS
  Two overall categories and four subthemes were identified: (1) Identification with being a cancer survivor included the subthemes of 'cancer identity' and 'cancer a thing of the past' and; (2) Emotional components included the subthemes of 'fear and anxiety' and 'gratitude and gaining perspective'. The analysis revealed that the same factor could act as either a motivator or a hindrance to successful transition in different survivors (e.g., fear of recurrence of cancer might be a barrier or a facilitator depending on the survivor's life experience).
  
  
  CONCLUSIONS
  Psychological factors are an important consideration when preparing cancer survivors for transition to adult long-term follow-up care. Identifying and addressing the individual psychological needs of childhood cancer survivors may improve the likelihood of their successful transition to adult care.
authors.affiliation: Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. Leeatg@gmail.com
authors.forename: Leeat
authors.initials: L
authors.lastname: Granek
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
authors.forename: Zahava R S
authors.initials: ZR
authors.lastname: Rosenberg-Yunger
authors.forename: Norma
authors.initials: N
authors.lastname: D'Agostino
authors.forename: Leila
authors.initials: L
authors.lastname: Amin
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Barr
authors.forename: Mark L
authors.initials: ML
authors.lastname: Greenberg
authors.forename: David
authors.initials: D
authors.lastname: Hodgson
authors.forename: Katherine
authors.initials: K
authors.lastname: Boydell
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klassen
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D011379:Prognosis; D017741:Survivors / Q000523:psychology*; D060305:Transition to Adult Care