Recent medical advances in cancer screening and treatments have led to dramatically decreasing mortality rates from cancer among children and adolescents. However, the cancer itself and the adverse effects of treatments remain severely devastating to their physical and psychological well-being, both during and after treatments. Numerous studies have demonstrated that regular physical activity is related to various physiological and psychological benefits for children and adolescents under cancer treatments. Nevertheless, a review of the literature reveals that children and adolescents commonly present declining levels of physical activity throughout their cancer treatments. There is so far no study has investigated the physical activity level and behaviour in particular, the influencing factors affecting the physical activity level among Hong Kong Chinese children and adolescents with cancer. Therefore, this study aimed (1) to assess and compare the physical activity levels and behaviour of healthy children and adolescents with those of children and adolescents undergoing cancer treatments and (2) to explore the various factors that influence the physical activity levels of children and adolescents with cancer in Hong Kong. A cross-sectional study, using both quantitative and qualitative approaches, was conducted. A total of 76 children and adolescents (9-to 18-year-olds) who were admitted for treatment of cancer in a paediatric oncology unit and 148 healthy counterparts who were participated in two health carnivals in Hong Kong were invited to participate in the study. Their physical activity levels, stages of change for exercise, self-efficacy for physical activity and quality of life were assessed and compared. A total of 25 participants with cancer were purposively selected for semi-structured interviews. The results of this study indicated that children and adolescents with cancer in current situation had significantly decreased levels of physical activity when compared with the premorbid situation or the healthy counterparts. The study also showed that children and adolescents with cancer presented significantly lower levels of physical activity, self-efficacy, stage of change for exercise and quality of life than the healthy participants. Furthermore, qualitative interviews revealed that the negative impacts from cancer and its treatments, the discouragement of and misunderstanding concerning physical activity, and the space limitations in Hong Kong were important factors that disengaged these young people from regular physical activity while under treatment. This study has addressed an literature gap by assessing the levels of physical activity, self-efficacy, stage of change, and quality of life among children and adolescents with cancer as compared to their healthy counterparts. The results provide further evidence that cancer and its treatments induce negative impact on the physical, psychological well-being and the quality of life in children and adolescents with cancer. It is essential for healthcare professionals to detect physical inactivity at an early stage so that appropriate interventions can be applied to correct any misunderstandings about physical activity among children and adolescents with cancer and their parents. Most importantly, interventions should be designed to promote the adoption of regular physical activity for these patients, with the aim of enhancing their physical and psychological well-being. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

published_or_final_version / abstract / toc / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Dentistry / Master / Master of Philosophy

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Increasing number of people is diagnosed with colorectal neoplasms (CRN) in the form of polyps or cancers. Colorectal cancer (CRC) is one of the most common causes of cancer deaths among Chinese in Hong Kong. Advances in diagnosis and treatments have increased the survival rate of CRN patients, resulting in a large group of cancer survivors. Preserving and maintaining health-related quality of life (HRQOL) has become an important direction in research and clinical care of patients with CRN. This research aimed to evaluate the HRQOL and its association with socio-demographics and disease-related characteristics among patients with CRN, and illustrate how HRQOL data could be converted to preference for the estimation of quality adjustment of life years in health economic evaluations. This research comprised of three parts. First was the establishment of the validity and reliability of the traditional Chinese version of Functional Assessment of Cancer Therapy-Colorectal (FACT-C) as a HRQOL measure for Chinese patients by a cross-sectional sample of 536 adult patients with CRN. Psychometric testing and concurrent validation of the FACT-C with European Organization for Research and Treatment of Cancer Core Questionnaire plus Colorectal-specific Module Questionnaire and the Short-Form 12-item Health Survey_Version2 (SF-12V2) were carried out. Second was a longitudinal study on the HRQOL of 554 CRN patients at baseline, six (n=479) and twelve (n=414) months of recruitment. The associations of HRQOL with socio-demographics and disease-related factors, and change of HRQOL over time were explored. Comparisons of HRQOL between CRN patients and the general population and among different CRN groups were made. Cross-sectional data were used to develop mapping functions to estimate SF-6D preference scores from FACT-C subscale scores. Third was the application of the health preference scores by CRN stages collected at baseline of the longitudinal study, in combination with survival data extracted from the literature in a Markov model on the cost-effectiveness of different CRC screening strategies (colonoscopy, guaiac and immunochemical fecal occult blood tests) in comparison to no screening in terms of quality-adjusted life-years gained. This research comprised of three parts. First was the establishment of the validity and reliability of the traditional Chinese version of Functional Assessment of Cancer Therapy-Colorectal (FACT-C) as a HRQOL measure for Chinese patients by a cross-sectional sample of 536 adult patients with CRN. Psychometric testing and concurrent validation of the FACT-C with European Organization for Research and Treatment of Cancer Core Questionnaire plus Colorectal-specific Module Questionnaire and the Short-Form 12-item Health Survey_Version2 (SF-12V2) were carried out. Second was a longitudinal study on the HRQOL of 554 CRN patients at baseline, six (n=479) and twelve (n=414) months of recruitment. The associations of HRQOL with socio-demographics and disease-related factors, and change of HRQOL over time were explored. Comparisons of HRQOL between CRN patients and the general population and among different CRN groups were made. Cross-sectional data were used to develop mapping functions to estimate SF-6D preference scores from FACT-C subscale scores. Third was the application of the health preference scores by CRN stages collected at baseline of the longitudinal study, in combination with survival data extracted from the literature in a Markov model on the cost-effectiveness of different CRC screening strategies (colonoscopy, guaiac and immunochemical fecal occult blood tests) in comparison to no screening in terms of quality-adjusted life-years gained. Psychometric analysis confirmed that FACT-C had satisfactory reliability, construct validity and responsiveness in Chinese patients Patients with CRN reported worse physical HRQOL but better mental HRQOL and similar health preference score compared to the general population. Disease severity indicated by tumor stage at initial diagnosis was the most significant determinant of HRQOL of CRN patients. Rectal cancer also significantly associated with a decrease in physical HRQOL and health preference scores. Markov modelling showed that immunochemical fecal occult blood (I-FOBT) yearly was the most effective and two-yearly was the most cost-effective screening strategy compared to no screening. / published_or_final_version / Family Medicine and Primary Care / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work / Master / Master of Social Sciences

published_or_final_version / Statistics / Master / Master of Philosophy

published_or_final_version / abstract / Community Medicine / Master / Master of Philosophy