Children and adolescents/young adults (AYAs) with cancer are a vulnerable population, susceptible to numerous late effects that may diminish their long-term psychosocial, physical, spiritual, and emotional health. Fostering positive psychosocial constructs?such as hope or optimism?during treatment and maintenance has been shown to correlate with improved rates of survival and quality of life in patients with cancer. To strengthen psychosocial care for children and AYAs with cancer, providers of childhood and AYA cancer care must be equipped with robust evidence gathered from high-quality patient reported outcome measures (PROMs). However, a necessary first step to improving psychosocial care via evidence-based PROMs is to systematically investigate the quality of existing PROMs. The long-term goal of this proposal is to use the meta-analytic technique to facilitate improved treatment outcomes in pediatric and AYA patients with cancer who undergo and survive treatment. The overall objective is to determine which PROMs are most appropriate and robust for the key psychosocial constructs in pediatric and AYA patients with cancer. This objective ultimately aims to improve psychosocial care for young cancer patients. The rationale for the proposed work is that pediatric and AYA patients with cancer are susceptible to numerous late effects that result from treatment and extend into survival. To accomplish the overall objective, I propose the following specific aims: (1) Identify key psychosocial constructs for pediatric and AYA patients with cancer; (2) Conduct a psychometric systematic review, meta-analysis, and risk of bias evaluation of PROMs that assess the key psychosocial constructs identified; (3) Apply comprehensive meta-analysis methodology to obtain a pooled reliability estimate for these PROMs, and conduct exploratory meta-regression to understand test or sample characteristics that account for variation in the reliability estimates across studies. This proposal is significant because it represents an evidence-based, methodological investigation of key psychosocial constructs and corresponding PROMs that aims to advance and strengthen psychosocial care for children and AYAs with cancer. This proposal is innovative because of its scope, methods, approach, and expected outcomes. Because I am using evidence-based, robust methodology for conducting and displaying the data of this scoping review, systematic review, and meta-analysis, I expect my study to result in the vertical advancement of pediatric and AYA oncology patient care. Furthermore, because these evidence-based approaches will be applied to an area of medicine in need of standardized PROMs in order to continue the upward trend in patient outcomes, my results are expected to have a positive impact on national and worldwide cancer outcomes. Furthermore, my data will fulfill important aspects of the National Cancer Institute mission statement by advancing scientific knowledge and helping people live longer, healthier lives. My mentorship team, which includes my primary sponsor, whose novel mentorship methods have resulted in 87 published studies in high impact factor journals and 277 medical student authorships in the last 4 years; my co- sponsor, a National Cancer Institute-funded AYA oncologist; and carefully selected expert research consultants, is ideally suited to accomplish my training and career goals.
The proposed research is relevant to public health because the identification of evidence-based patient reported outcome measures is ultimately expected to strengthen the psychosocial care for children and AYAs with cancer. Should the psychosocial care of children and AYAs with cancer be improved, the short- and long-term quality of life of these patients will be improved. Thus, the proposed research is relevant to the part of the National Cancer Institute?s mission that pertains to advancing scientific knowledge and helping people live longer, healthier lives.
