Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress

Abstract

Background.A subgroup of adolescent and young adult (AYA) survivors of cancer during adolescence report high levels of psychological distress. To date, evidence-based psychological interventions tailored to the cancer-related concerns experienced by this population are lacking. The present study aimed to (1) examine the feasibility and preliminary efficacy of an individualized cognitive behavioral therapy (CBT) intervention for AYA survivors of cancer during adolescence; and (2) identify and conceptualize cancer-related concerns as well as maintaining factors using cognitivebehavioral theory. Methods. A single-arm trial, whereby AYA survivors of cancer during adolescence (aged 17-25 years) were provided individualized face-to-face CBT at a maximum of 15 sessions. Clinical outcomes were assessed at baseline, post-intervention, and three-month follow-up. Intervention uptake, retention, intervention delivery, and reliable change index scores were examined. An embedded qualitative study consisted of two unstructured interviews with each participant pre-intervention. Along with individual behavioral case formulations developed to guide the intervention, interview data was analyzed to identify and conceptualize cancer-related concerns and potential maintaining factors. Results. Ten out of 213 potential participants invited into the study were included, resulting in an overall participation rate of 4.7%. Nine participants completed the intervention, with respectively seven and eight participants completing the postintervention and three month follow-up assessment. The majority of reported cancerrelated concerns and maintaining factors were conceptualized into four themes: social avoidance, fear of emotions and bodily symptoms, imbalance in activity, and worry and rumination. Conclusions. Given significant recruitment difficulties, further research is required to examine barriers to help-seeking in the AYA cancer survivor population. However, the conceptualization of cancer-related concerns and maintaining factors experienced by the population may represent an important first step in the development of psychological support tailored toward AYA cancer survivors' unique needs. How to cite this article Hagström J, Ander M, Cernvall M, Ljótsson B, Wiman HW, von Essen L, Woodford J. 2020. Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress. PeerJ 8:e8714 http://doi.org/10.7717/peerj.8714 Ander M, Thorsell Cederberg J, Von Essen L, Hovén E. 2018. Exploration of psychological distress experienced by survivors of adolescent cancer reporting a need for psychological support. PLOS ONE 13(4):e0195899

Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors: Protocol for the Bounce Back Study

“…However, in today's digitally interconnected society, we did not anticipate that this requirement would preclude many AYAs from participating. Despite these limitations, our study participation rate remained quite high and was higher than those commonly noted in other behavioral trials [12,14]. Finally, we excluded non-English-speaking participants as the study measures and program were targeted towards an English-speaking audience.…”

“…Other psychosocial programs targeting AYAs have been individually delivered, did not include mind-body skill acquisition, or focused on teaching a single skill (ie, mindfulness, positive psychology) for stress reduction [12][13][14][15][16][17]25,26]. Few have targeted a wide range of AYAs, particularly during the early posttreatment period.…”

“…Although acute distress symptoms can persist for several years after treatment, peak levels of distress typically coincide with the first few years of treatment completion [10,11]. These consequences combined may increase AYAs' risk for cancer-related morbidity and early mortality, yet targeted programs to support AYAs' ability to cope with stress in the years following treatment completion are lacking [12][13][14][15][16][17].…”

Online, Group-Based Psychological Support for Adolescent and Young Adult Cancer Survivors: Results from the Recapture Life Randomized Trial

“…Larger studies are needed to generate more conclusive data. Yet, there is growing evidence about the recruitment challenges faced by researchers testing online mental health interventions [ 31 , 109 , 110 , 111 , 112 ], with one study recruiting only 10 AYA cancer survivors out of 213 potential eligible participants contacted (4.7%) [ 113 ]. Reviews have highlighted that randomized psychosocial studies average lower opt-in rates in pediatric psycho-oncology (45.5%) relative to studies examining health behaviors (78.2%) or neurocognitive functioning (91%); group-based interventions also tend to yield lower opt-in rates [ 114 ].…”

Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden

“… 29 e-MH interventions may help overcome practical barriers associated with accessing traditional face-to-face psychological support (eg, geographical, financial and time-related barriers) 30 that have been observed within the AYACCS population. 31 Furthermore, e-MH is associated with anonymity and privacy 32 thus potentially overcoming barriers associated with public stigma. Indeed, research has identified that the provision of e-MH interventions may be a potential solution for the AYACCS population.…”