1. Fuerst, Mark L.

Article Content

SAN DIEGO-A brief in-person intervention can improve psychosocial health in adolescents and young adults living with cancer, according to a new study.

young cancer patient... - Click to enlarge in new windowyoung cancer patients. young cancer patients

Adolescents and young adults with cancer are at risk for poor psychosocial outcomes, perhaps because they have yet to learn the skills needed to navigate the burdens of illness, said lead author Abby R. Rosenberg, MD, Director of Palliative Care and Resilience Research at Seattle Children's Research Institute.


Psychosocial stress from cancer is common and is often a major detriment to quality of life. Although many programs provide some level of psychosocial support for patients and families, very few provide standardized tools to manage this stress, she said.


Creating an Interventional Tool

Rosenberg and colleagues set out to determine whether a novel, brief, age-appropriate, skills-based intervention would improve psychosocial outcomes. The intervention, called Promoting Resilience in Stress Management (PRISM), improved resilience and quality of life, increased hope, and lowered distress in the majority of patients.


Rosenberg presented the findings at the 2017 Palliative and Supportive Care in Oncology Symposium (Abstract 176).


"The experience of cancer is stressful in all realms, but we tend to focus more on physical symptoms than the equally important social and emotional challenges," noted Rosenberg. "This is particularly true for adolescents and young adults who already struggle with normal developmental changes. When you throw cancer into the mix, it can become much harder."


PRISM is a brief intervention targeting stress management, goal-setting, cognitive reframing, and meaning-making. It emerged from a theory of resilience that puts forth three sets of resources that can help manage adversity: internal resources, such as stress-management or mindfulness skills; community resources, such as social support; and existential resources, such as spirituality and the search for purpose.


Previously, the researchers found that internal and existential resources were more teachable than tapping community resources. PRISM was tested in an earlier feasibility study with young patients with either diabetes or cancer.



In the new pilot, randomized controlled trial, 100 English-speaking patients ages 12-25 years who were diagnosed with new or newly recurrent cancer were randomly assigned to receive PRISM or usual psychosocial care. The intervention was delivered in four 30-minute to hour-long one-on-one sessions with a trained research associate, and then followed by a family meeting. Patients completed patient-reported outcome (PRO) surveys at the time of enrollment and 6 months later.


Of the 100 patients, 92 patients completed baseline responses (48 PRISM and 44 usual care). Of those who completed baseline responses, 73 percent were ages 13-17 years and 27 percent were ages 18-25 years. Attrition was similar in each arm and primarily due to medical complication and/or death. About three-quarters of patients in both the PRISM and usual care group completed 6-month PROs.


The results show the intervention improved psychosocial well-being. Those who received the intervention had improvements in resilience, cancer-related quality of life, hope, and distress compared with those who received usual psychosocial care. In addition, the incidence of depression was much lower in the intervention group (6%) as compared with the usual care group (21%).


PRISM cultivated internal resilience resources that strengthen stress management and goal-setting, as well as existential resilience resources that strengthen cognitive reframing and meaning-making. "Meaning-making is basically deriving some personal perspective or purpose from adversity," stated Rosenberg. "For example, we found that many young cancer patients in our study identified things for which they were grateful, despite their cancer experience."


Regardless of which group they were in, all participants received standard psychosocial supportive care, including a dedicated social worker and access to psychologists, child-life specialists, and other experts in adolescent and young adult oncology care, as needed.


All but four of the PRISM recipients chose to participate in the family meeting following their one-on-one skills-training sessions. "We included the family meeting because teens told us they wanted to share with their parents, and parents told us they wanted to know what their children had learned," said Rosenberg. "While the specific impact of this meeting is yet to be determined, we hope it will guide families so that there is continued support of teen or young adult patients."


She added: "We need to include a much larger cultural demographic in future studies. Beyond that, we also need to determine if this type of intervention could translate to other centers where usual care may not be as comprehensive as what we have here."


The investigators would also like to test PRISM in patients with advanced cancers and possibly expand to other diseases, such as cystic fibrosis.


ASCO Expert Andrew S. Epstein, MD, Medical Oncologist at Memorial Sloan Kettering Cancer Center in New York, commented: "This intervention represents a beacon of hope for these young patients. Cancer is a daunting disease regardless of a person's age. Adolescents and young adults with cancer face an especially unique and challenging experience as they deal with the physical and emotional difficulties of cancer treatment at the same time they are coping with the normal stresses of adolescence and entering adulthood."


Mark L. Fuerst is a contributing writer.