Self-Perceptions 1
Running head: SELF-PERCEPTIONS OF ADOLESCENTS
Self-Perceptions of Adolescents with a History of Cancer
Erika Webber, Honors Student
Dr. Margaret Halter, PhD, PMHCNS
The University of Akron
April 1, 2011
Self-Perceptions 2
Abstract
The purpose of this study was to: 1) examine the self-perception of individuals who were
treated for cancer and are currently in their adolescent years, and 2) identify demographic and
clinical variables associated with self-perception in adolescent cancer survivors.
Cancer is a leading cause of morbidity and mortality among adolescents. The number of
adolescents who survive cancer is rising dramatically each year as treatment methods improve.
These survivors suffer from the traumatic experiences associated with the cancer diagnosis and
treatment. Even when treatment is over, they may continue to experience an altered selfperception.
Erik Erikson (1950) asserts that adolescents are in the identity versus role confusion stage
of their lives and that maladaptive development in one stage inhibits future success in later
psychosocial stages. Experiencing cancer may disrupt the goal of achieving a stable identity and
interfere with the ability to transition to the next stage, intimacy versus isolation in young
adulthood.
The 27 participants were patients ages 13-23 at a cancer survivor clinic within a pediatric
hospital. Months since diagnosis ranged from 15-204 months. Potential participants were
approached, asked to participate in this study, and consent was obtained. About half of the
participants were reached via mail. In the case of minors, parental consent was sought. If
agreeable, they completed a 10-item questionnaire that elicits self-perceptions such as how they
view themselves, their bodies, and their lives both before and after the cancer diagnosis.
Data was analyzed electronically using Statistical Package for the Social Sciences
(SPSS). Descriptive data was generated regarding self-perception; descriptive-correlational
Self-Perceptions 3
analyses were created on demographic/clinical variables and self-perception. Majority of the
participants viewed themselves as normal, attractive, and well but slightly vulnerable and
different from before their illness. Usual schedules for the survivors had been slightly altered
with academic performance and dating most influenced by having had cancer. Embarrassment
from hair loss, surgical scars, chemoport, and most of all, weight change, was a shared
experience among survivors, especially those of female gender.
As the months since diagnosis increased in time, the participants rated having a more
positive view of his or her self. The variable ―view‖ was correlated at the 0.05 significance level
with a correlation of -0.45. Months since diagnosed was also negatively correlated at the 0.01
level (r= -0.55) with the influence cancer has had on the survivors’ desire to go out in public.
Responses chosen for current quality of life were negatively correlated at r= 0.46 (p=0.05) with
age. The older the participant, the lower rating of quality of life post-diagnosis was given.
Self-Perceptions 4
Cancer is the leading cause of death from disease in adolescents (Corey, Haase, Azzouz,
& Monahan, 2008). The Centers for Disease Control and Prevention (CDC, 2009) estimate that
approximately 16 out of 100,000 children/adolescents are diagnosed with cancer in the United
States. In 2004, 2,223 children/adolescents died from cancer (CDC, 2007). The increased
survival rate of all childhood cancers is reaching 70% (Stevens, Kagan, Yamada, Epstein,
Beamer, Bilodeau, & Baruchel, 2004).
Researchers suggest that survival during the adolescent ages may result in either a
positive or a negative perspective on life, dependent on individual circumstances and various
factors (Jörngården, Mattsson, & Essen, 2007). Survivors may experience late effects which are
―adverse side effects of cancer and its treatments‖ and can occur in individuals anywhere from
months to years following diagnosis (Eiser, 2007, pg 1140). Development of late effects may
present as physical, emotional, psychological, sexual, or cognitive changes in the adolescent.
Healthcare providers now have to learn how to recognize these late effects and how to
treat the survivors’ symptoms accordingly. This study focuses on psychological issues involving
self-perceptions of adolescents with a history of cancer. Some psychological late effects include
depression, anxiety about future relapse, Post-Traumatic Stress Disorder, low quality of life, poor
adaption to diagnosis and treatment, and negative self-perception (Jörngården, Mattsson, &
Essen, 2007).
Despite studies investigating the relationship between adolescent cancer and
psychological late effects, few studies have examined self-perceptions of adolescents with a
history of cancer. No studies have correlated age, gender, ethnicity, or time since diagnosis with
self-perception. Therefore, the purpose of this study was to investigate the self-perceptions of
Self-Perceptions 5
adolescent cancer survivors. The project aimed to address the following research questions: How
do adolescents view themselves in regards to their experience with cancer? How do gender, age,
and time since diagnosis affect the self-perceptions of adolescents with cancer?
Review of Literature
Body image concerns may arise from loss of hair, surgical removal of body parts, weight
loss, fatigue, or mucositis (Abrams, Hazen, & Penson, 2007). Adolescents have described
themselves as sick, tired-looking, and abnormal (Larouche & Chin-Peuckert, 2006). The change
in body image is hard to deal with when the adolescents feel a sense of loss and rejection
(Stevens et al, 2004). Autonomy is lost when parents become overprotective and do not allow the
adolescent to go to social events in fear of getting sick or tired while immunocompromised.
Healthy adolescents enjoy the ability to drive and hang out with friends whereas an oncology
patient relies on his or her parent for transportation to appointments, decision-making during
treatments, and physical, emotional, and financial support throughout the disease process
(Abrams et al, 2007). In order to develop a healthy sense of identity, adolescents require an
identity unique from their parents’ or friends’ identities (Evan et al, 2006). Emotional and
physical dependence could alter the formation of an independent identity.
Some barriers to forming friendships and the social life of adolescents with cancer are
appointments, feeling sick and tired, and ultimately missing school and social activities (Abrams
et al, 2007). Overprotective parents, feeling too tired or sick, or fear of going out into public all
influence the adolescents’ decision to remain inside at home (Larouche & Chin-Peuckert, 2006).
Not attending school on a regular basis will negatively affect the cognition of the adolescent, his
or her social life, meeting friends or intimate partners, and the ability to learn about sexual health
Self-Perceptions 6
(Evan et al, 2006). Years following diagnosis, the adolescent can feel depressed about the loss of
time and experiences during their adolescent years (Stevens et al, 2004).
Adolescents with cancer who have low self-esteem use coping mechanisms to override
their perceived negative characteristics. They may enhance their physical looks through the use
of make-up, wigs, fashionable clothes, or even plastic surgery (Larouche & Chin-Peuckert,
2006). Another strategy used by this population is hiding physical changes that were a result of
cancer treatments. Adolescents use wigs or hats to mask the loss of hair and commonly wear
particular clothing to cover scars or treatment equipment like mediports. Peer-shields are often
used to give a sense of protection to patients with cancer. When going out into public, the
adolescent will bring their friend(s) who act as a ―bubble or safety blanket‖ to hide the
adolescent or defend him or her when needed (Larouche & Chin-Peuckert, 2006, pg 205). Once
the adolescents feel ready to go into public, they test the waters by attempting vulnerable
situations or public areas. They may do this by entering a more secure place like the grocery
store before going to the county fair. The adolescents may cope by increasingly exposing more
clues to their diagnosis by feeling more comfortable going out with less make-up on and
eventually without a wig.
Theoretical Framework
According to Erik Erikson’s (1950) psychosocial stages of development, adolescents are
in the identity versus role confusion psychosocial stage of their lives (as cited in Abrams, Hazen,
& Penson, 2007). Erikson proposed that maladaptive development in one stage inhibits future
success in later psychosocial stages. Hence, maladaptive development in the adolescent identity
versus role confusion stage may compromise the young adulthood stage of intimacy versus
Self-Perceptions 7
isolation. Cancer may greatly affect the outcome of this necessary maturation. Missing out on
normal adolescent experiences may cause concern when the survivor tries to find a partner,
which then may contribute to the development of low self-esteem. Since adolescence is a time of
forming a positive self-identity and increasing independence from family and friends, the effects
of cancer may lead to negative self-perceptions and a lack of autonomy (Corey et al, 2008).
Based on this theoretical framework, it is predicted that adolescents with cancer will display
negative self-perceptions.
Methods
Research Design
A quantitative-descriptive-correlational research design was used to investigate the selfperceptions of adolescents with cancer. A 10-item questionnaire was used to collect self-reported
data related to the impact of having cancer as an adolescent. This data was correlated with
demographic variables such as gender and age. The experiment received permission from the
University’s and hospital’s Institutional Review Boards to ensure ethical practice with the
vulnerable population.
Sample and Setting
The convenience sample consisted of adolescents between the ages of 13 and 23 who
have been diagnosed with cancer. Inclusionary criteria include the following: subjects must be
(a) literate and (b) be receiving treatment from the survivor clinic. Subjects were not excluded
based on gender or ethnicity. A sample of 27 was used for the pilot study.
Self-Perceptions 8
The setting of this study was at Akron Children’s Hospital at the pediatric oncology
department’s outpatient survivor clinic. Each recommended individual was given the opportunity
to complete a questionnaire and turn it in an envelope with the other anonymous surveys. Due to
low sample size, about half of the participants received consent and the questionnaire via mail
and chose to return the completed questionnaire to Akron Children’s Hospital.
Instrument
Basic demographic data including gender, age, and ethnic origin were elicited. The length
of time since diagnosis was measured as actual number of months and with an item asking
subjects to write in the length of time.
A Self-Perception Survey was developed for use in this pilot study. Descriptors obtained
from a qualitative study (Larouche & Chin-Peuckert, 2006) were used as a base for the survey.
Comments from this qualitative study included: ―I look ugly,‖ ―People look at me,‖ and ―I’m not
like the rest of the people‖ (LaRouche & Chin-Peuckert, 2006, pg 203). The survey was
validated by experts in the areas of oncology and psychology, and survivors of adolescent
cancer. Their feedback was elicited and incorporated into the survey. There has been no
statistical validation of this tool.
Self-perceptions were measured by items asking subjects to rate how they view
themselves, their bodies, and cancer artifacts that may have impacted self-perception. Subjects
rated responses on 5-point Likert scales. For example, participants were asked to select words
describing how they view themselves like unattractive, vulnerable, or sick and to rate the amount
of discomfort felt with physical changes, such as hair loss, chemotherapy access port, surgical
scars, and weight changes.
Self-Perceptions 9
Results
Demographics
There were a total of 27 participants although a few participants handed in incomplete
demographic forms. The sample was composed of 14 males, 12 females, and one missing
gender. Of the 24 ages reported, the mean age was 17.8 (SD = 2.8) with a minimum age of 13
and maximum of 23. Median age was 18 years. The sample primarily consisted of Caucasian
participants at 85% (n = 23). There was 4% (n = 1) African-American, 4% (n = 1) Hispanic, and
4% (n=1) Lebanese. The range of months since diagnosis of cancer was from 15-204 months
with a mean of 90.0 (SD=54.6). All but one participant reported on age, race, and months since
diagnosis.
Cancer Specifics
Twenty –five respondents identified types of cancer. There were 16 neoplasms of the
blood or lymphatic system, 3 neoplasms of the bone, 3 neoplasms of an organ, 2 neoplasms of
the muscle, and 1 neoplasm of the joints. The most common type of cancer identified was
leukemia.
Type of Cancer as Identified by Participant
Acute Lymphoblastic
Leukemia
B cell non Hodgkins
Lymphoma
Ewings Sarcoma
Hodgkins Lymphoma
Leukemia
Lymphoblastic
Myelodysplastic Syndrome
Non-Hodgkins Lymphoma
Osteosarcoma
Pleuropulmonary Blastoma
7
25.9
1
3.7
2
3
2
1
1
1
1
1
7.4
11.1
7.4
3.7
3.7
3.7
3.7
3.7
Self-Perceptions 10
Rhabdomyosarcoma
Synovial Sarcoma
Wilm's tumor
No response
Total
2
1
2
2
27
7.4
3.7
7.4
7.4
100.0
Primary Site of Cancer as Identified by Participant
Abdomen
Blood
Bone
Femur
Groin
Kidney
Knee
Lung
Neck/Chest
Shin
Spine
Tibia
No
response
Total
1
4
1
1
3
2
1
1
3
1
1
2
3.7
14.8
3.7
3.7
11.1
7.4
3.7
3.7
11.1
3.7
3.7
7.4
6
22.2
27
100.0
View
All items regarding the respondents’ views of themselves were summed for a total score
which indicated overall positive or negative view. The resulting score had a mean score of 12.4
(SD = 4) and a range of 5-22, 5 being the most positive view of self and 25 being the most
negative view of self. Current view of self was negatively correlated (p=0.05) with months since
diagnosis (r=-.45). As the months since diagnosis increased in time, the participants rated having
a more positive view of his or her self.
The more abnormal respondents rated their current view of his or herself, the greater
feeling of vulnerability (r=0.54; p=0.01). Also, the more different the survivors felt from pre-
Self-Perceptions 11
diagnosis, the more abnormal (r=0.61; p=0.01) and vulnerable (r=0.4; p= 0.05) ratings they
chose for their self-perceptions. Those participants who viewed themselves as more ―sick‖ than
―well‖, also had more ratings on a 5 point Likert-scale of feeling ―unattractive‖ as opposed to
―attractive‖ (r=0.48; p=0.05), and more ―vulnerable‖ than ―invulnerable‖ (r=0.46; p=0.05).
Current View of Self by Gender
Gender Mean N
SD
Female
12.6
11 5.0
Male
12.8
13 2.6
Total
12.7
24 3.8
Activities
Respondents were asked to identify the effect that cancer has had on their normal
activities which included their schedule, academic performance, making friends, and dating. The
1-5 point Likert scale ran from ―no effect‖ to ―great effect‖ with a potential score of 4-20.
Responses were summed and a total activity score was recorded for each person. Activity scores
ranged from 4-20 with a mean score of 10.2 (SD = 5.4).
Activities was the name of a variable computed from the addition of each participant’s
responses to the effect cancer has had on usual activities like academic performance and making
friends. This ―activities‖ variable was correlated with the variable referred to as ―view‖, which
summed the responses of viewing the self as attractive versus unattractive, sick versus well, etc.
There was a positive correlation of r=0.54 (p=0.01) of view and activities. The greater the effect
cancer has had on the individuals’ usual activities (daily schedule, dating, making friends, and
academic performance), the more effect cancer has had on their wanting to go out in public
(r=0.52; p= 0.01).
Similarly, those who had poorer views of the self, expressed a less desire to go in public
influenced by their experience with cancer (r=0.54; p=0.01). For respondents who had higher
Self-Perceptions 12
scores, or a more negative perception of self (unattractive, vulnerable, sick, abnormal, and
different from pre-diagnosis), portrayed a positive correlation (r=0.4), significant at the 0.05
level, with the greater effect cancer has had on behaviors like wearing make-up, fashionable
clothes, hiding particular areas of the body, along with diet and exercise changes.
Quality of Life Pre/post Diagnosis
Participants were asked to rate the overall quality of life before the diagnosis of cancer
and a current quality of life on a 1-5 point Likert scale, 1 being ―poor‖ and 5 being ―great‖. The
maximum response given for quality of life before diagnosis and current was rated as a 5
whereas the minimum response was 3 (SD= 0.8) and 2 (SD= 0.7) respectfully. Table I provides
the difference in means and standard deviations between quality of life pre-diagnosis and postdiagnosis. The responses chosen for current quality of life were negatively correlated at r= 0.46
(p=0.05) with age. The older the participant, the lower the quality of life post-diagnosis.
Table I Descriptive Statistics of Quality of Life
N
Quality Before
Quality Now
Minimum Maximum
26
3
5
27
2
5
Mean
4.42
4.37
Std.
Deviation
.758
.742
Embarrassment
The survivors used the Likert-scale, 0 being ―no effect‖ and 5 being ―greatest effect‖, to
choose the extent to which participants felt discomfort, anxiety, or embarrassment from changes
from the disease or treatment process. The items included hair loss, chemotherapy access port,
surgical scars, and weight change. Weight change had the largest variation among those who felt
that weight change had no effect on feelings of embarrassment (25.9%) and those who felt
Self-Perceptions 13
cancer had the greatest effect on their feelings of discomfort (25.9%). More participants chose
―large effect‖ or ―greatest effect‖ at 48.1% as opposed to the 34.4% who chose either ―no
effect‖, ―small effect‖, or ―medium effect‖.
Those respondents who have experienced greater embarrassment with a chemoport have
also felt embarrassed with their change in weight from cancer. Embarrassment associated with
chemoport had a correlation of 0.47 (p=0.05) with embarrassment of weight change influenced
from cancer. Those people who felt greater embarrassment from having a chemoport were the
same individuals who also described themselves as being sicker. The positive correlation
(r=0.43) is statistically significant at the 0.05 level.
Embarrassment with Regards to Gender
All
Female
Male
Hair Loss
Frequency Percent Frequency Frequency
Valid no effect
6
22.2
2
4
small
6
22.2
3
2
medium
4
14.8
0
4
large
4
14.8
3
1
greatest effect
6
22.2
6
0
Not applicable
1
3.7
0
1
Total
27
100.0
14
12
All
Female
Male
Frequency Percent Frequency Frequency
Valid no effect
8
29.6
1
6
small
5
18.5
1
4
medium
5
18.5
5
0
large
2
7.4
2
0
greatest effect
5
18.5
4
1
Not applicable
2
7.4
1
1
Total
27
100.0
Chemo Port
Self-Perceptions 14
All
Female
Male
Surgical Scar Frequency Percent Frequency Frequency
Valid no effect
3
11.1
0
3
small
7
25.9
4
3
medium
9
33.3
5
4
large
2
7.4
2
0
greatest effect
4
14.8
2
1
Not applicable
2
7.4
1
1
Total
27
100.0
All
Female
Male
Weight Change
Frequency Percent Frequency Frequency
Valid no effect
7
25.9
4
2
small
2
7.4
0
2
medium
3
11.1
3
0
large
6
22.2
1
5
greatest effect
7
25.9
5
2
Not applicable
2
7.4
1
Total
27
100.0
Behaviors
In order to assess which behaviors have been influenced by cancer, respondents used the
5-point Likert scale that had ―no effect‖ (0) to ―great effect‖ (5) for wearing make-up, wearing
fashionable clothes, choosing certain clothes to hide parts of his or her body, diet, and exercise.
The more cancer had an effect on choosing clothes to hide respondents’ bodies, the
greater the influence cancer has had on wearing fashionable clothes (r=0.69; p=0.01) and on diet
changes due to cancer (r=0.46; p=0.05). Cancer influenced the diet of those who also felt cancer
affected a change in exercise (r=0.52, p=0.01).
Self-Perceptions 15
Wearing Makeup
Frequency Percent
Valid no effect
10
37.0
medium
1
3.7
large
1
3.7
greatest effect
1
3.7
Not
14
51.9
applicable
Total
27
100.0
Hiding Body
Frequency Percent
Valid no effect
15
55.6
small
2
7.4
medium
2
7.4
large
1
3.7
greatest effect
3
11.1
Not
4
14.8
applicable
Total
27
100.0
Diet
Frequency Percent
Valid no effect
12
44.4
small
4
14.8
medium
5
18.5
large
1
3.7
greatest effect
4
14.8
Not
1
3.7
applicable
Total
27
100.0
Choosing Fashion Clothes
Frequency Percent
Valid no effect
16
59.3
small
2
7.4
medium
2
7.4
large
2
7.4
greatest effect
1
3.7
Not
4
14.8
applicable
Total
27
100.0
Self-Perceptions 16
Excercise
Frequency Percent
Valid
no effect
9
33.3
small
3
11.1
medium
6
22.2
large
3
11.1
greatest
5
18.5
effect
Total
26
96.3
Missing System
1
3.7
Total
27
100.0
Public
Participants were asked to rate the effect cancer has had on his or her desire to be out in
public. The 5-point Likert-scale and the participants’ responses ranged from 0 (―no influence) to
5 (―greatest influence‖). Eighteen of the twenty-six (69.2%) respondents to this question felt that
cancer had no influence on wanting to be in public. Only 8 chose either ―small influence‖,
―medium influence‖, ―large influence‖, or ―greatest influence‖. Months since diagnosis was
negatively correlated at the 0.01 level (r= -0.55) with the influence cancer has had on the
survivors’ desire to go out in public. The longer the time since diagnosed, the more the
participant was willing to go in public.
Dependence
A Likert-scale was provided for survivors to rate how dependent he or she felt on others
following a cancer diagnosis. All 27 participants responded and not a single survivor felt that he
or she was not dependent on others post diagnosis. However, 4 (14.8%) rated their dependence
as ―small‖, 7 (25.9%) chose ―medium dependence‖, 5 (18.5%) as ―large dependence‖, and 11 or
40.7% who chose the highest choice, felt the ―greatest dependence‖ on other people.
Self-Perceptions 17
A correlation of 0.50 was statistically significant at the 0.01 level for survivors who felt
different from pre-diagnosis and felt dependent on others since their diagnosis of cancer. Those
with a greater dependence on other people following diagnosis, also rated being less able to
handle stressful situations since diagnosis (r=-0.44; p=0.05). The variable ―view‖ (normality,
attractiveness, wellness, vulnerability, and difference) was positively correlated (r=0.4) with the
feeling of being more or less dependent on others since diagnosis of cancer. This means that
those with a more negative self-perception (unattractive, sick, abnormal, etc) felt more dependent
on others since their diagnosis (p=0.05).
Difference
Participants were asked how different they feel from before a diagnosis of cancer. There
was one missing data, 3 respondents who rated ―no different‖, 6 who chose ―small difference‖, 6
for ―medium difference‖, 3 rated ―large difference‖, and 8 for ―greatest difference‖ from how
they felt pre-diagnosis. View was positively correlated (r=0.74; p=0.01) with feeling different
from pre-diagnosis. Feeling of difference following diagnosis was correlated (r=0.59) with the
variable ―activities‖ (usual schedule, academic performance, making friends, and dating) at the
0.01 significance level.
Stress
The change in the respondents’ ability to handle stressful situations was also measured
using a 5 point Likert-scale. Two people did not respond, no one chose ―a lot less able‖, 7.4%
felt they were ―somewhat less able‖, 18.5% rated in the middle of the scale, 29.6% were
Self-Perceptions 18
―somewhat more able‖, and 92.6% ―a lot more able‖ to handle stressful situations following their
diagnosis.
Descriptors
The final segment of the questionnaire asked participants to check all that apply. A
variety of adjectives were provided to choose from representing how the cancer survivors would
describe themselves. The descriptive words in which respondents identified with were presented
in a negative traits column versus positive traits column. Since the respondents had the choice to
pick only those traits in which they identified with, there were not 27 responses for each
descriptive antonym pair.
18.5% of those who chose between vulnerable and invulnerable identified with being
―vulnerable‖ while 44.4% felt they are ―invulnerable‖. Only 3 survivors did not choose weak or
brave, 1 identified with ―weak‖ and 23 of the 27 participants considered themselves ―brave‖,
which was the most chosen descriptor. Bravery was portrayed as one participant commented, ―If
I didn’t get cancer I wouldn’t be the person I am today so I guess it was okay that I got it because
I’d rather it happen to me then someone else‖. Likewise, 1 participant chose ―unmotivated‖, 7
did not choose either, and 19 (70.4%) felt they are ―motivated‖ individuals. 22.2% chose ―shy‖
as a personality descriptor while 51.9% consider themselves ―outgoing‖.
Twenty of the 27 participants felt they were ―open-minded‖ while 5 said ―close-minded‖.
21 people from the sample identified with being ―independent‖ and only 2 chose ―dependent‖.
The choice between describing the self as conscientious or unconscientious was the least
deviating between those who did not respond to either word or those who chose one descriptive
characteristic over the other. 40.7% did not select either, 33.3% feel ―conscientious‖, 25.9% as
―unconscientious‖.
Self-Perceptions 19
Discussion
Overall, the majority of the sample seemed to agree that cancer has had a tremendous
effect on a variety of aspects of their lives. However, many of the survivors rated their quality of
life highly along with more positive perceptions of the self. The adolescent survivors proved to
be more optimistic than hypothesized. Adolescents with a history of cancer viewed themselves as
normal, attractive, well, slightly vulnerable, and different from before the illness. Their usual
schedules have been slightly altered, dating changes experienced, and most of all, changes in
academic performance have followed the cancer treatments.
While quality of life was rated highly for both pre and post-diagnosis, post-diagnosis
quality of life was given a slightly lower number. Changes in appearance such as chemoport,
surgical scars, hair loss, and weight change caused from cancer and its treatments have led to
embarrassment and discomfort, with change in weight being the most significant. Alterations in
compensating behaviors for poor self image are not used by many survivors besides slight
changes in diet and exercise influenced from having had cancer.
Younger participants seem to more resilient from the traumatic experiences induced from
having cancer. This may be due to the simple fact that the younger participants still have some
adolescent years to make up for the time lost to cancer treatments. Older adolescents have busier
lifestyles and want to engage in normal activities separate from their parents but have been
restricted from the cancer experience. Males and females rated a lot of their perceptions similarly
but females had a greater response to feelings of anxiety, embarrassment, and discomfort from
physical changes.
Self-Perceptions 20
While there were only a few correlations between demographics and responses given on
the questionnaire, there were many correlations between the negative versus positive trends of
responses given from each participant. The congruency of answers among the participants gives
some validity to the test that it was measuring what it was intended to. For example, the worse
the view of self, the more influence cancer has had on everyday activities of life.
Adolescents are expected to successfully relate with a positive identity of the self before
moving past the identity vs. role confusion psychosocial stage to intimacy vs. isolation. Cancer
may directly impact adolescent patients’ identities and cause confusion regarding who they are
as people. It is difficult for people who feel quite dependent on others to form an individual
identity separate from friends and family. Feeling vulnerable, unattractive, and different as
people all amount to negative identifying characteristics that will inhibit a transition to intimacy.
Dating, making friends, and forming intimate relationships were issues of concern for some
respondents. Some of the isolation felt by a few participants was made obvious throughout the
questionnaire but especially by a statement made by one saying:
―I don’t feel comfortable talking to many people about this. I don’t want people to know some of
the things that go through my head. I do well most of the time but a few times a year I’ll have a
couple days where it seems like nothing will ever be ok‖.
Limitations
The limitations of this study include the small sample size and the absence of variability
within the sample. The sample of 27 participants lacked ethnic diversity. Of the 26 given
ethnicities in the demographic section, 23 identified their selves as Caucasians. This is a
Self-Perceptions 21
surprising finding considering the diverse population treated at this urban setting hospital. This
brings up further questions regarding access to care for minorities or differences in desires to
seek additional holistic care following successful cancer treatments. Correlations of this
demographic variable could not be computed because of the lack of diversity.
Months since diagnosis seemed to have a larger range than originally expected. The
survivor clinic continues seeing patients regardless of age or time since diagnosis. That being
said, the clinic treatment is completely voluntary and there may be a bias in responses due to the
choice of all respondents to attend a clinic for interdisciplinary care. Those who are more
proactive in ways to help the mind and body may have a more outgoing personality and desire to
receive help.
The data collected from this sample could have been easier to interpret next to a variety
of control groups. Some responses, whether be positive or negative, may be influenced from
expected developing adolescent characteristics and not particularly from cancer. A sample of
teens without a history of cancer, those not yet in remission, or those who are terminally ill
would all be specific populations to compare responses.
Additionally, the questionnaire’s reliability and validity have not been rigorously
examined. A lot of the questions asked to the participants were assumed to measure
characteristics of their self-perceptions. With the submission of the questionnaires being
confidential and anonymous, confusion regarding questions was not addressed. Once the
informed consent was explained and the participant received the questionnaire, no further
interaction occurred between the researcher and participants in order to maintain privacy.
Self-Perceptions 22
To ease the approval from Institutional Boards, permission to view medical charts was
not asked of the researchers. This led to some incorrect or incomplete information given by the
patients. An example includes the type of cancer that each participant had. Some survivors put
their specific type of cancer such as ―acute lymphoblastic leukemia‖ whereas others wrote
general types like ―leukemia‖ and ―lymphoma‖. The differences in the patients’ documentation
of cancer types made grouping and correlations difficult. I did not use ―type of cancer‖ as a
demographic to compare result differences because my grouping of neoplasm may have been
inaccurate due to the self-report.
Conclusion
The final data from this project will benefit healthcare professionals who will be working
with populations similar to the study’s sample. It will help them understand adolescent survivors’
ways of thinking and allow caregivers to intervene accordingly. Research in this area will help
healthcare providers in all fields understand feelings and thoughts of this particular population.
Interventions such as attending a survivor clinic where counseling, physical therapy, dietary,
genetics, and medical care are readily available would be an interesting variable to compare
effectiveness against other interventions or lack thereof.
Ultimately, future studies will aid adolescent oncology patients in identifying with peers
of similar age undergoing similar vigorous treatments. As evidenced by some of the participants’
responses, feelings regarding self-perceptions influenced by cancer has not only been absent in
research, but in survivors’ personal lives. Some felt comfortable and relieved to come upon
similar feelings among peer counterparts who have gone through the experience of cancer with
statements like ― I am very glad you are doing research on this subject. Thank you so much!‖
Self-Perceptions 23
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