Transition to adult care in survivors of childhood cancer: a review of psychological obstacles

Abstract

Background: Transition from paediatric to adult care is an important step for many childhood cancer survivors when they reach adult age. Various barriers have been recognised on the patient/survivor, provider and health system level. Knowledge about cancer, treatment and the adult care system, or readiness to assume responsibility have been acknowledged as important aspects for successful transition. Other psychological aspects might be important barriers to successful transition. We aimed to summarise the findings on psychological obstacles preventing successful transition to adult care in childhood cancer survivors. Methods: We searched PubMed without language restrictions including all years up to 5 August 2015. We used search terms addressing childhood cancer, transition, and psychosocial aspects. Findings: We found 213 articles fitting the search terms, and excluded 175 and 30 articles after screening titles/abstracts and full texts, respectively. We extracted the information on psychological obstacles for transition from 8 articles (6 qualitative and 2 mixed-methods studies). The following obstacles for successful transition to adult care were reported: worry about leaving paediatric oncology, avoidance of bad memories (anxiety-provoking health-related information or reminders about cancer history), wanting to be normal and leaving cancer behind, fear and anxiety of adverse outcomes, lack of self-advocacy and communication skills. Discussion: Psychological aspects are of great importance in addition to knowledge, availability of a competent adult care provider, insurance and other system related aspects. Transition programmes should aim to address psychological obstacles at an early stage of the transition process to guide survivors successfully to long-term follow-up in adult care.