Psychosocial Interventions for Adolescents and Young Adults With Cancer: An Integrative Review

Abstract

Background: Adolescents and young adults with cancer sit in a precarious position facing an increasing cancer incidence while incidence in other age groups has been declining. A cancer diagnosis at this age imposes undue distress in a demographic with limited coping resources creating psychosocial needs that differ from children and older adults. Addressing psychosocial needs early in the cancer trajectory is postulated as an approach to address distress, improve quality of life, and promote optimal outcomes from therapy. The purpose of this review is to identify current successful approaches to psychosocial care in adolescents and young adults receiving therapy for cancer. Method: An integrative review of publications identified through six relevant databases was conducted. Thematic analysis was performed to identify types of interventions followed by assessment of publication level of evidence, quality, and a critique of the effectiveness of interventions. Findings: A total of 6,292 articles were identified and 17 met inclusion criteria for this review. Thematic analysis and critique identified six themes for intervention approaches with mixed outcomes: creative expression, promoting peer interactions, individual coaching, employing technology, promoting physical activity, and clinical interactions. Discussion: Adolescent and young adult psychosocial needs while receiving treatment are complex and best addressed with the involvement of an interdisciplinary team. Effective interventions include those that have been tailored to the patient and consider the individual’s developmental stage. Interventions that promote autonomy and decision making, provide privacy, are executed in individual sessions, and facilitate social/peer interactions have been more successful in improving psychosocial outcomes.

Better Together: acceptability, feasibility and preliminary impact of chronic illness peer support groups for South African adolescents and young adults

“…Peer support models are recommended as part of best practices to improve youth medication adherence [39,72], reduce disease-related http://onlinelibrary.wiley.com/doi/10.1002/jia2.26148/full | https://doi.org/10.1002/jia2.26148 stigma [73,74] and improve other mental health outcomes [38]. Yet, to the best of our knowledge, the current effectiveness evidence of these models is overwhelmingly derived from approaches that provide peer support to youth living with the same chronic condition [73][74][75][76][77]. Focusing solely on one chronic condition may limit the full potential of peer support groups by preventing youth from capitalizing on the increased knowledge that stems from sharing experiences and disease management habits across conditions.…”

Feasibility and Acceptability of Bright IDEAS-Young Adults: A Problem-Solving Skills Training Intervention

“…The feasibility of this study was demonstrated by adequate enrollment (67.8%), retention (80.0%), and adherence to the intervention (5.2 out of 6 sessions completed). No a priori benchmarks were established, but the enrollment and retention rates were similar to the prior study of adolescents and young adults newly diagnosed with cancer in a pediatric setting (71% enrollment, 80% retention) [16]. Withdrawal from the study was predominantly due to worsening health and feeling too ill to complete the sessions.…”

“…To our knowledge, only one such intervention focused on promoting resilience among newly diagnosed adolescent and young adult patients (aged 12-25 years) in a pediatric setting [17,18]. Results showed improvements in resilience, cancer-specific quality of life, and distress, but may not translate to adult oncology settings or older young adults, given that the sample was from a pediatric oncology setting with the majority of participants being under 18 years of age [16].…”

“…Despite the documented needs of this group, there is a lack of evidence-based interventions to address the unique concerns of the young adult population [15]. In particular, there are few skills-based interventions that target young adults newly diagnosed with cancer [16]. To our knowledge, only one such intervention focused on promoting resilience among newly diagnosed adolescent and young adult patients (aged 12-25 years) in a pediatric setting [17,18].…”

Study Protocol to Evaluate Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults With Cancer

“…AYAs with cancer report worse severity of stress than younger and older persons with cancer (Kazak et al, 2010); up to 48% of AYAs report posttraumatic stress disorder symptoms during therapy (McCarthy et al, 2016). Stress, distress, and psychosocial functioning alone have adverse effects on toxicity profiles in AYAs during therapy (Haase & Phillips, 2004; Thornton et al, 2020) but may also correlate with higher inflammation. Stress elicits a cascade of proinflammatory responses and, in the oncology population, has been associated with more severe symptom burden (Jakovljevic et al, 2021; Kwekkeboom et al, 2018; Ma et al, 2018; Weber & O’Brien, 2017).…”