Adolescents with Cancer: The Influence of Close Relationships o ...

This is followed by a brief review of the rather voluminous amount of literature on social relationships of children/adolescents, and a specific discussion of the impact of cancer on peer relationships and friendships. Finally, a brief summary of the small body of literature on health-related behaviors (i.e., substance use, diet, sexual activity, and physical activity) among adolescents with cancer is presented in order to provide the framework for the current study.

The Nature of Cancer

Illness Characteristics

Classification

Childhood cancer is not a single disease entity but rather a spectrum of different malignancies that can vary by type of histology, site of disease origin, race, gender, and age (Ries, Percy, & Bunin, 1999). However, it is important to note that, for children, classification of malignancies is based on morphology rather than the primary site of origin, as is the case in adults (Steliarova-Foucher, Stiller, Lacour, & Kaatsch, 2005). The need for a standard classification of malignancies to compare incidence and survival rates across regions and time periods prompted the development of the International Classification of Childhood Cancer, currently in its third edition (i.e., ICCC-3). The ICCC-3 is based on the International Classification of Diseases for Oncology (ICD-O-3) and stipulates three levels of hierarchical classification: (a) Level 1, 12 main diagnostic groups; (b) Level 2, 47 diagnostic subgroups; and (c) Level 3 (optional), extended classification of selected diagnostic subgroups (Steliarova-Foucher et al., 2005).

Prevalence

Pediatric cancer is relatively rare, with most recent data indicating that approximately 8,000 children and 11,500 adolescents (ages 15 to 19 years) were diagnosed with cancer in the United States in 1999 (Castellino & Hudson, 2002).