key: cord-289828-3k088z9n
authors: De Salvo, Andrea; Amicucci, Matteo; Ciaralli, Italo; Secco, Domitilla; Miele, Evelina; Bevilacqua, Francesca; Milano, Giuseppe Maria
title: How to be together and carry on our project activities during COVID‐19 pandemic in Rome
date: 2020-08-03
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.28431
sha: 
doc_id: 289828
cord_uid: 3k088z9n

nan

An oncologic diagnosis during adolescence or young adulthood (AYA) affects many spheres of a patient's life. 1 One of the most impacted is represented by peer relationships, which are a key component of adolescence. The isolation felt during the cancer cure due to estrangement from friends can have detrimental effects for this developmental stage, 2 thus it is necessary to offer specific multidisciplinary support during the disease. [3] [4] [5] In the last few years, numerous initiatives and dedicated programs were developed worldwide with the aim to help these patients to deal with diagnosis and treatments, and also to allow them to imagine, dream, design, learn, and maintain relationships with their peers in and outside the hospital walls.

Recent research reported advantages of using online communities for patients with cancer. 6 These studies indicate that participation in these groups increases perceived knowledge and ability to manage the illness and decreases self-reported anxiety and fears, permitting the patients to have peer support. 7 Its efficacy is widely demonstrated in coping and educational programs. 8 In 2017, we started a project, named "4You" for the AYA referred to our Pediatric Hematology/Oncology Department at Bambino Gesù Children's Hospital in Rome.

We put together patients in treatment and those who are no longer, creating a virtuous circle, which is one of the main purposes of our project. In past years, "4You" realized several activities including theme parties at discos, talks for the students' schools about adolescents and cancer, photo exhibitions, radio-talk, and fashion-line creation.

On March 9, 2020, due to the COVID-19 pandemic, which affected Italy with 183 269 cases of infected people and 23 576 associated deaths (update April 24 data Italian Institute of Health), various restrictive measures were taken in our hospital to ensure the safety of oncology patients, with the suspension of the recreational activities and laboratories offered in the ward by volunteers and staff.

In this paper, we describe how we have readapted part of our assistance to (a) maintain the activities of "4You," (b) permit peer relationship and confront between our patients with our equip, and (c) respond to the emerging psychologic troubles due to pandemic isolation. 9 In this view, what could be better than the simple idea to activate a virtual room where our patients could stay together and safe? Thus was born Play4You-our digital playground.

First, we decided to adopt the old role play games (RPGs), such as memory, pictionary, fightlist, quiz, trivial, names things and cities, guess who?, taboo, and lupus in fabula. Further, a leaflet was developed in order to inform and invite the patients to the virtual space. Then, a link access via the digital platform "Zoom" was sent daily to all participating patients, choosing together which RPGs to play.

The Play4You has been set to be active for 2 h everyday in the presence of the educators and one psychologist; moreover, for 2 h a day, educators offered the possibility of one-to-one game sessions for those prefering individual meetings.

To date, the leaflet has been given to 25 patients; currently we have five different participants per day joining simultaneously to game sessions ( Figure 1 ). No patient asked for individual sessions.

As we hoped, several topics were touched during the game sessions, which included troubles about their disease, concerns about COVID-19, and also speech about the "best moment" they had during therapy. When someone among them left the transplant department, this infused hope to those who were still under treatment. They also talked about common teenage issues such as the world of school, experiences with their friends in the past, and their daily routine during the lockdown period. Arguments emerged about the end of the restrictive measures, for example, Erika said, "who knows when it ends?," Luca said, "I want to see my friends," and Michela said, "could I go back to school?" Another topic was plans for future, for example, Luca said, "when this will be over, I want to go to the beach with friends!" and Michela said, "I want to dine out with my friends." We reached our objective.

Spending time together during game sessions allowed our adolescents to normalize this stressful condition and to realize they are not alone because all of them have similar fears and hopes.

AYA with cancer are more vulnerable to experience high levels of fear and Play4You gave them a coping strategy based on game sharing. 10 The art of the game turned out to be once again very important for our patients; even if at a distance from each other, they were still together. Nevertheless, a main role was played by the same professional figures whom they already knew from the beginning of cancer experiences. Similarly, the constant presence of some cancer survivors on the Play4You was extremely positive (positive transfer).

The aim of this report was to share with the community that takes care of AYAs; this model is able to reach and help more patients at home, in hospital or elsewhere, simply by using relatively old tools such as Internet connection, individuals' smartphones, and selected RPGs.

Psychosocial dimensions of cancer in adolescents and young adults

The experience of loneliness among young adult cancer patients

Correlates of social support in young adults with advanced cancer

Starting an adolescent and young adult program: some success stories and some obstacles to overcome

Health and supportive care needs of young adult cancer patients and survivors

Online communities as sources of peer support for people living with cancer: a commentary

Internet-based program for coping with cancer: a randomized controlled trial with hematologic cancer patients

Coping with cancer: a web-based educational program for early and middle adolescents

Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China

Prevalence and correlates of high fear of cancer recurrence in late adolescents and young adults consulting a specialist adolescent and young adult (AYA) cancer service