From "invincibility" to "normalcy": coping strategies of young adults during the cancer journey

Nonsupport Experiences of Young Adult Cancer Patients: Prevalence, Acceptability, and Outcomes of Not Receiving Support

This study provides foundational data regarding instances of nonsupport (i.e. instances when support was expected from someone but not received) in the cancer context. In a sample of 205 young adult cancer patients from 22 countries, approximately three out of every five patients reported having experienced nonsupport at some point during their cancer journey. Men and women patients were approximately equally as likely to have experienced nonsupport and were approximately equally likely to be recalled by a cancer patient as a nonsupporter. Results showed that patients who had experienced nonsupport reported worse mental and physical health, greater depression, and greater loneliness than those who had not experienced an instance of nonsupport. Patients were also presented with a previously published list of 16 reasons why people choose to forgo communicating support to cancer patients, and patients rated each reason's acceptability. Nonsupport reasons that assumed communicating support would create a burden for the patient (e.g. providing support would create a privacy issue; the supporter feared losing control of their own emotions) were rated as more acceptable. Reasons involving the nonsupporter making assumptions or decisions about the broader social support process were seen as less acceptable (e.g. communicating support does not help; assuming support is not desired). Together, these results demonstrate the prevalence and impact of nonsupport on cancer patients' health outcomes and provide justification for nonsupport as an important avenue for future social support research.

Coping with stress styles and the level of perceived stress in hematopoietic cell transplant patients

OBJECTIVE

Hematopoietic stem cell transplantation (HSCT) is considered an integral part of therapy in many hematological and non-hematological malignancies. The procedure can be highly stressful for patients. The primary objective of this study was to compare stress assessments in HSCT patients, depending on their stress coping style (CS) and type of treatment (autologous vs. allogeneic HSCT).

METHODS

A short longitudinal study was conducted between May 2021 and June 2023 among patients with hematological cancers undergoing HSCT. The study involved four time points: the day of admission to hospital - T1, the day before HSCT - T2, 6 days after HSCT - T3, and the day of discharge - T4. Participants completed the Coping Inventory for Stressful Situations (CISS) on T1, and the Distress Thermometer (DT) on T1-T4. Descriptive statistics and a repeated measures ANOVA were conducted.

RESULTS

A total of 128 participants completed the study: 54.2% female, mean age 48.7 years. They were divided into: (1) five groups based on their CS: task-oriented, emotion-oriented, avoidance-oriented, mix-oriented, differential-oriented; (2) two groups based on treatment type. The analyses showed significant differences in stress between the CS study groups (p = 0.001). The emotion-oriented group had the highest stress levels during the hospitalization period. There was also a significant time effect (p < 0.001): stress levels increased during the hospitalization period, peaking 6 days after HSCT, and decreased at discharge.

CONCLUSIONS

Stress levels depend on coping styles and time points during the hospitalization period, which should be taken into account in planning psychological interventions for HSCT patients.

Describing and Exploring Coping Strategies among Those Diagnosed with Cancer as an Adolescent or Young Adult: A YACPRIME Study

A greater understanding of how young people cope with a cancer diagnosis is needed in order to inform age-appropriate supportive care. This paper describes the coping strategies used and explores relationships between coping strategies and personal, medical, and psychological variables among young adults (YAs) diagnosed with cancer. YAs (n = 547, mean age = 34.05 ± 6.00 years) completed an online survey, including the Brief COPE and measures of psychological functioning. Descriptive statistics and bivariate correlations were computed. Acceptance, self-distraction, positive reframing, and planning were the most used coping strategies by this sample. There were small (r = -0.09) to large (r = 0.51) significant relationships between personal, medical, and psychological variables and selected coping strategies. Coping with a cancer diagnosis early in life remains poorly understood. Identifying additional correlates and exploring inter- and intrapersonal variation in coping strategy use is required.

Social isolation and social connectedness among young adult cancer survivors: A systematic review

BACKGROUND

Social isolation and connectedness are social determinants of health that have demonstrated effects on cancer-related outcomes. These constructs have been systematically evaluated among pediatric and older adult cancer populations. In this review, the authors evaluated the prevalence, correlates, and psychosocial implications of social isolation and connectedness among young adult (YA) cancer survivors aged 18-39 years.

METHODS

Peer-reviewed articles published in English before June 2021 were identified from database searches and included articles' reference lists according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included articles described studies that assessed social isolation and/or connectedness among YA cancer survivors.

RESULTS

In total, 5094 unique records were identified; 4143 were excluded after title/abstract screening, and 907 were excluded after full-text review. Forty-four articles were included. Few studies used validated measures or directly assessed social isolation or connectedness. Social isolation was similarly prevalent among YAs and older cancer survivors and noncancer populations. Demographic, clinical, and behavioral risk and protective factors for social isolation were identified. Social isolation was related to worse psychological well-being, whereas social connectedness was often, but not always, related to better psychological well-being.

CONCLUSIONS

This growing literature underscores the relevance of social isolation and connectedness as important health determinants among YA cancer survivors. The identified risk and protective factors can identify YAs who especially may benefit from screening for social isolation. Future studies are needed that directly, reliably, and validly evaluate social isolation and connectedness to inform the development of interventions to decrease isolation and increase connectedness.

Striving towards normality in an unpredictable situation. A qualitative interview study of how persons newly diagnosed with incurable oesophageal and gastric cancer manage everyday life

PURPOSE

Getting an incurable oesophageal or gastric cancer diagnosis is a major stressful life event associated with severe physical, psychosocial and existential challenges. To provide timely and efficient support, based on patients' experiences, the aim of the study was to explore how patients newly diagnosed with incurable oesophageal and gastric cancer manage everyday life.

METHOD

Semi-structured interviews were conducted with 12 patients 1-3 months after being diagnosed with incurable oesophageal or gastric cancer. Four participants were interviewed twice, which resulted in 16 interviews. Data were analysed with qualitative content analysis.

RESULTS

An overall theme, "Striving towards normality in an unpredictable situation", with three related themes - "Trying to comprehend the disease", "Dealing with the consequences of illness" and "Re-evaluating what is important in everyday life" - and seven sub-themes were identified. The participants described an unexpected and unpredictable situation, in which they strived to maintain their normal life. Amidst struggling to manage problems related to eating, fatigue and an incurable diagnosis the participants talked about the importance of focusing on the positive and normal aspects of life.

CONCLUSIONS

The findings in this study point to the importance of supporting patients' confidence and skills, particularly with regard to managing eating, so that they can hold on to their normal life as much as possible. The findings further point to the possible benefit of integrating an early palliative care approach and could provide guidance for nurses and other professionals on how to support patients post diagnosis.

Prevalence and associated factors of psychological distress among young adult cancer patients in Japan

OBJECTIVES

Adolescent and young adult (AYA) cancer patients may be at high risk of experiencing psychological distress because their diagnosis came during a key time of consolidation of identity and social growth. This study aimed (1) to examine the prevalence of psychological distress among AYA cancer patients within a year of diagnosis to long-term survivors and (2) to describe socio-demographic and cancer-related characteristics associated with psychological distress.

METHODS

In a cross-sectional web-based survey, patients who scored 5 or more on the Kessler Psychological Distress Scale were assessed for significant psychological distress. Logistic regression examined whether demographics, clinical variables, and social support were associated with psychological distress.

RESULTS

A total of 206 young adult cancer patients participated. The median age at the survey was 34.5 years (range: 22-39 years), and 87.4% were female. The prevalence of psychological distress was 55.3%. Psychological distress among patients diagnosed within a year and long-term survivors (≥10 years since diagnosis) was significantly higher than patients 1-4 years since diagnosis. Pain, decrease in income after a cancer diagnosis, experience of negative change in work/school after a cancer diagnosis and poor social support were significantly associated with psychological distress.

SIGNIFICANCE OF RESULTS

Over half of young adult patients had significant psychological distress in Japan. Our findings potentially contribute to the intervention components for distress management among AYA cancer survivors.

"The simple life experiences that every other human gets": Desire for normalcy among adolescents and young adults with advanced cancer

BACKGROUND

Adolescents and young adults (AYAs) with advanced cancer identify normalcy as an important component of quality end-of-life care. We sought to define domains of normalcy and identify ways in which clinicians facilitate or hinder normalcy during advanced cancer care.

PROCEDURE

This was a secondary analysis of a qualitative study that aimed to identify priority domains for end-of-life care. Content analysis of semi-structured interviews among AYAs aged 12-39 years with advanced cancer, caregivers, and clinicians was used to evaluate transcripts. Coded excerpts were reviewed to identify themes related to normalcy.

RESULTS

Participants included 23 AYAs with advanced cancer, 28 caregivers, and 29 clinicians. Participants identified five domains of normalcy including relationships, activities, career/school, milestones, and appearance. AYAs and caregivers identified that clinicians facilitate normalcy through exploration of these domains with AYAs, allowing flexibility in care plans, identification of short-term and long-term goals across normalcy domains, and recognizing losses of normalcy that occur during cancer care.

CONCLUSIONS

AYAs with cancer experience multiple threats to normalcy during advanced cancer care. Clinicians can attend to normalcy and improve AYA quality of life by acknowledging these losses through ongoing discussions on how best to support domains of normalcy and by reinforcing AYA identities beyond a cancer diagnosis.

Psychosocial Distress Due to Interference of Normal Developmental Milestones in AYAs with Cancer

Cancer in the adolescent and young adult phase poses additional challenges to this period of development that is crucial to the transition to independence. This report provides a brief review of normal developmental milestones in this age range while highlighting the disruptive effects of cancer. We focus on the psychological burden of cancer in patients aged 15–39 years and explore the application of the total pain model to highlight the psychological/emotional, social, and spiritual aspects of non-physical pain. We also briefly review posttraumatic growth and resilience. Lastly, we provide a review of areas for possible development and future research.

Factors Affecting Participation in Leisure Activities in Patients after Breast Cancer Surgery

Background: The purpose of this study was to investigate the factors related to patient’s participation in leisure activity in breast cancer patients with axillary lymph node dissection at 3 months after surgery. Methods: In total, 160 women who were employed before their surgery were evaluated. Age, body mass index (BMI), employment, level of lymph node dissection, marital status, children, coresident household members, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion test, upper limb function, quality of life, and patient’s participation in leisure activity were evaluated. Results: Patients who undertook leisure activities constituted the leisure activity group, and patients who did not constituted the non-leisure activity group. Global health status, emotional function, social function, and dyspnea were significantly different between the leisure activity group and the non-leisure activity group at 3 months after surgery (p < 0.05). Regarding factors that affected participation in leisure activities, logistic regression analysis showed that only participation in leisure activities before surgery was significantly associated with participation in leisure activities at 3 months after surgery (p < 0.05). Conclusion: Patients who did not participate in leisure activities prior to surgery were unlikely to participate 3 months after surgery and thus require intervention to encourage their involvement.

Exploring Young People's Experience of Ending Active Cancer Treatment: When the "Little Cancer Treatment Bubble" Pops

BACKGROUND

The end of active cancer treatment is described as a stressful period for adolescents and young adults (AYAs). However, research evidence describing the experience of AYAs as they transition from active treatment into follow-up care is scarce.

OBJECTIVE

We aimed to understand AYAs' experiences within the first 12 months of ending active treatment.

METHODS

Data were collected using semistructured interviews, which were digitally recorded and transcribed verbatim. Qualitative analysis of transcripts was used to identify key themes/subthemes.

RESULTS

Eleven AYAs (8 female participants), diagnosed with cancer aged 17 to 25 years and 19 to 26 years at point of interview, participated. At time of interview, 7 were within 6 months of treatment completion, and in 4 participants, treatment ended 6 to 12 months prior. Three main themes were identified: (1) challenges of social reintegration and self-identity, (2) expectations versus the lived experience of ending treatment, and (3) sudden loss of the safe "bubble" of treatment.

CONCLUSIONS

Adolescents and young adults were underprepared for and challenged by the unexpected emotional and physical consequences of ending active cancer treatment.

IMPLICATIONS FOR PRACTICE

Young people require information and support to prepare for ending active treatment and reintegration to everyday life. Preparation for the short- and long-term physical, social, and psychological impact of a cancer diagnosis even when treatment ends will assist young people in managing this transition. Further research is required to develop and test interventions to provide timely, structured, and equitable information and support at the end of treatment to better prepare AYAs for the challenges they may face as treatment ends.

Emotional approach coping among young adults with cancer: Relationships with psychological distress, posttraumatic growth, and resilience

OBJECTIVE

Cancer, particularly, during young adulthood, can evoke difficult emotions, interfere with normative developmental activities, and challenge coping responses. Emotion-regulating coping efforts aimed at active emotional processing (EP) and emotional expression (EE) can be beneficial to cancer adjustment and perceptions of positive growth. However, it may be that EP and EE work differently to influence well-being. This study examines relationships of EP and EE with psychological distress, posttraumatic growth (PTG), and resilience. We expect that EP will be positively associated with PTG and resilience, whereas EE will be negatively associated with psychological distress.

METHODS

Young adults with cancer (M age  = 34.68, N = 57) completed measures of emotional; approach coping (EP and EE), psychological distress (depressive symptoms, fear of cancer; recurrence [FCR]) and indicators of positive adjustment and growth (resilience and PTG).

RESULTS

Greater use of EP was associated with higher resilience (β = 0.48, p = 0.003) and PTG (β = 0.27, p = 0.05), whereas greater use of EE was associated with lower resilience (β = -0.33, p = 0.04). The EE × EP interaction was significant for FCR (β = 0.29, p = 0.04) such that low EE was associated with lower FCR in those with high EP. Interaction effects were not significant for depressive symptoms, resilience, or PTG.

CONCLUSIONS

Findings highlight differing relationships between EP and EE among young adults with cancer. Interventions aimed at increasing emotion-regulating coping strategies may prove useful in facilitating positive adjustment and growth, strengthening young adults' ability to cope with the diverse effects of disease, treatment, and survivorship.

Concerns and Fear of Esophageal Cancer in Relatives of Patients with Cancer: a Qualitative Study

INTRODUCTION

Due to its complications and mortality, cancer is a vital public health problem and one of the most frightening diseases, and its development causes a sense of risk, problems, and discomforts for all, including family of patients. The aim of this study was to elaborate on the concerns and fear of esophageal cancer in relatives with cancer illness.

METHODS

Using a content analysis approach, this qualitative study was carried out in Golestan, North of Iran, in 2018. Participants were one of the family members of a patient with esophageal cancer who were selected purposefully. Data were collected using semi-structured and deep interviews and continued until data saturation was achieved. Twenty-three participants were interviewed. Interviews were transcribed line by line and were coded and categorized, and concepts were extracted accordance with qualitative content analysis approach, using MAXQDA 11 software.

RESULT

Following data analysis on the concerns and fear of cancer among relatives of patients, the main themes "fear of social consequences," "fear of treatment consequences," "fear of psychological consequences," "cancer phobia," "concern about lack of information on the disease," "fear of disease reactions," and "fear of disease-related changes" were extracted.

CONCLUSIONS

Family of patients with esophageal cancer were afraid of disease-induced consequences and lack of knowledge about the disease. Through educating people about the symptoms of the disease, we can reduce their fears and empower them for self-caring and preventing cancer.

Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25-39 Years Old in the UK National Health Service

AIMS

Adolescents and young adults aged 15-39 years with cancer face unique medical, practical and psychosocial issues. In the UK, principal treatment centres and programmes have been designed to care for teenage and young adult patients aged 13-24 years in an age-appropriate manner. However, for young adults (YAs) aged 25-39 years with cancer, little access to age-specific support is available. The aim of this study was to examine this possible gap by qualitatively exploring YA care experiences, involving patients as research partners in the analysis to ensure robust results.

MATERIALS AND METHODS

We conducted a phenomenological qualitative study with YAs diagnosed with any cancer type between ages 25 and 39 years old in the last 5 years. Participants took part in interviews or focus groups and data were analysed using inductive thematic analysis. Results were shaped in an iterative process with the initial coders and four YA patients who did not participate in the study to improve the rigor of the results.

RESULTS

Sixty-five YAs with a range of tumour types participated. We identified seven themes and 13 subthemes. YAs found navigating the healthcare system difficult and commonly experienced prolonged diagnostic pathways. Participants felt under-informed about clinical details and the long-term implications of side-effects on daily life. YAs found online resources overwhelming but also a source of information and treatment support. Some patients regretted not discussing fertility before cancer treatment or felt uninformed or rushed when making fertility preservation decisions. A lack of age-tailored content or age-specific groups deterred YAs from accessing psychological support and rehabilitation services.

CONCLUSIONS

YAs with cancer may miss some benefits provided to teenagers and young adults in age-tailored cancer services. Improving services for YAs in adult settings should focus on provision of age-specific information and access to existing relevant support.

Avoir sa santé en main : le sentiment d'habilitation tel que perçu par les jeunes adultes souffrant d'un cancer avancé

Contexte

Le sentiment d'habilitation sur sa santé (health related empowerment) est un concept fondamental des soins centrés sur la personne. Toutefois, on en sait peu sur la manière dont ce concept s'articule chez les jeunes adultes ayant un diagnostic de cancer avancé.

Objectif

Explorer le sentiment d'habilitation à la lumière des expériences de soins de santé vécues par les jeunes adultes en phase de cancer avancé.

Cadre et participants

Douze jeunes adultes (âgés de 21 à 39 ans) ont été recrutés dans un grand centre de cancérologie de Montréal, au Québec.

Méthodologie

Des entretiens en profondeur durant entre 36 et 90 minutes ont été menés individuellement, enregistrés et retranscrits mot pour mot, puis analysés par thèmes.

Résultats

Tout au long de l'expérience du cancer, les participants ont témoigné du désir soutenu de participer activement à leur traitement et à leurs soins. Quatre thèmes sont ressortis des données décrivant les processus d'attente, de prise en charge de la maladie, de mise en action et de recadrage. Sous-jacents à ces thèmes se trouvent les notions de conscience du corps, les obstacles à surmonter pour obtenir des soins, l'optimisation de la santé et la réflexion sur l'héritage qu'on laisse derrière soi.

Conclusions

De façon générale, les participants voulaient demeurer en contrôle de la situation malgré les multiples difficultés inhérentes à un cancer de stade avancé. Si elles sont corroborées par d'autres recherches, ces conclusions pourraient orienter les approches de soins en oncologie afin qu'elles soient véritablement adaptées aux besoins des jeunes adultes.

The Role of Spirituality in Patients Undergoing Hematopoietic Stem Cell Transplantation: a Systematic Mixed Studies Review

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) has become the standard treatment for many diseases, but it is an intense and distinctive experience for patients. HSCT-related mortality is present throughout the whole process of transplantation, from pretransplantation to recovery. Long-term rehabilitation and the uncertain risk of death evoke feelings of vulnerability, helplessness, and intense fear. Zimmermann et al. proposed that spiritual well-being is an important dimension of quality of life and that patients at the end stage of life require spiritual support in addition to physical care, psychological care, and social support. Therefore, the purpose of this review is to examine the role of spirituality in the process of HSCT.

METHOD

A systematic mixed studies review (SMSR) was based on Pluye and Hong's framework to understand the role of spirituality in patients' experiences while undergoing HSCT. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to report the results of integration.

RESULTS

Fifteen original qualitative studies, 19 quantitative studies, and one mixed method study were included in the systematic mixed studies review. The evidence from the review revealed the following three themes: the spiritual experiences of HSCT patients, the spiritual coping styles of HSCT patients, and the spiritual need changes brought about by HSCT.

DISCUSSION

Few medical institutions currently offer spiritual healing, although HSCT patients with different cultural backgrounds may have different spiritual experiences and spiritual coping styles. Psychotherapists or nurses should be considered to provide spiritual care for patients undergoing HSCT, to help patients cope with disease pressures, promote HSCT patients' comfort, and improve their quality of life.

Taking control over our health: Empowerment as perceived by young adults living with advanced cancer

Background

Health-related empowerment is a key concept in person-centred care. However, little is known of its core elements in young adults diagnosed with advanced cancer.

Objective

To explore empowerment in the context of young adults' healthcare experiences who are now in advanced stages of cancer.

Setting & Participants

Twelve young adults (aged 21 to 39 years) were recruited from a large cancer centre in Montreal, Quebec.

Methods

In-depth interviews lasting between 36 and 90 minutes were conducted individually, audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

Results

Throughout the cancer trajectory, participants reported a sustained desire to be actively involved in their treatment and care. Four themes emerged from the data representing processes of waiting, managing, acting, and revisiting. Subsumed under these were notions of body ownership, facing obstacles to care, optimizing health, and (re)considering their legacy.

Conclusions

Overall, participants wanted to remain in control of their situation despite the multiple challenges related to advanced cancer. If corroborated further, these findings should inform supportive cancer care approaches that are truly tailored to the needs of young adults.

Being a teenager and cancer patient: What do adolescents and young adults with cancer find valuable and challenging with their friends and cancer peers?

Purpose: This study examined Adolescent and Young Adult (AYA) cancer patients' experiences with friends and cancer friends (peers) throughout their cancer journey.Research approach: Qualitative, thematic analysis.Participants: Twelve AYA diagnosed with cancer, treated within the past five years.Methodological approach: Individual semi-structured interviews, focusing on friend and peer experiences pre-/post-diagnosis, during and after treatment.Findings: Overarching themes of 'valued' vs. 'challenging' aspects with friends and peers.Interpretation: Friend and peer relationships were both valuable, but in different ways. Friends provided general support and helped AYA feel like a normal teenager, while peers provided targeted support and helped AYA feel like a normal teenager with cancer. Peers had an intimate understanding of cancer, whereas poor understanding by friends led to further challenges such as avoidance and being dismissive. Peer relations were notably challenged by a premature confrontation with mortality. Friendships evolved and changed throughout the cancer journey.

Motivations for cancer history disclosure among young adult cancer survivors

PURPOSE

To gain an in-depth understanding of the motivations for cancer history disclosure and/or non-disclosure among young adult cancer survivors.

METHODS

Using a constructivist grounded theory approach, semi-structured telephone interviews were conducted with breast and testicular cancer survivors diagnosed between the ages of 18 and 39 from across Canada.

FINDINGS

Twenty-eight young adult cancer survivors (16 female; 12 male) participated in this study. Analysis of the interviews revealed two basic motivational systems for disclosure at play: approach-focused motivations geared towards a positive outcome (desire for understanding, acceptance, support and to promote cancer awareness) and avoidance-focused motivations which are geared towards avoiding a negative outcome (fear of discrimination/stigmatization, unwanted attention, pity, loss of privacy, and rejection). Those exhibiting approach-focused motivations were more likely to disclose than those expressing avoidance-focused motivations. Participants also described a series of situational/contextual factors (social/cultural context, relevance, situation/timing, person disclosing, audience/confidant, and time passed since cancer diagnosis) which had the potential to change or influence the disclosure decision despite overarching motivations to disclose or not.

IMPLICATIONS FOR CANCER SURVIVORS

Gaining a better understanding of the cancer history disclosure decision processes of young adult cancer survivors can help them to better adapt and socially reintegrate back into their pre-cancer lives after the completion of treatment. Acknowledging and understanding the disclosure decision process and communication challenges faced by young cancer survivors can also be beneficial to healthcare professionals in the development and provision of better support interventions and informational resources to help improve psychosocial well-being after cancer.

"My Insides Feel Like Keith Richards' Face": A Narrative Analysis of Humor and Biographical Disruption in Young Adults' Cancer Blogs

In this thematic narrative analysis, I examine how three young adult (YA) cancer survivors use humor and the five functions of illness-related storytelling in personal blogs maintained across the cancer trajectory to describe and counter their age-distinct biographical disruption. In 370 blog entries, YA narrators employed humor to facilitate biographical reconstruction and achieve "aligning moments" with audiences. Researchers and practitioners can use YA blogs to better understand the interpersonal health communication challenges associated with medical decision-making, altered social identities, the "void" following the completion of primary treatment, uncertainty about disclosure, and social isolation from other YA survivors.

Balancing Hope and Risk Among Adolescent and Young Adult Cancer Patients with Late-Stage Cancer: A Qualitative Interview Study

PURPOSE

Previous studies have called for further research to explore adolescent and young adult (AYA) decision-making in the context of advanced cancer to understand the perspectives of this understudied population. We conducted a qualitative study with patients and providers to better understand the decision-making experience of AYA patients with advanced stages of cancer.

METHODS

Semistructured qualitative telephone interviews were conducted from April 2016 to October 2016. English-speaking AYAs and healthcare providers were recruited through the social media sites Twitter and Facebook. AYAs were eligible if they were aged 18-39 years at diagnosis and self-reported having metastatic cancer; any provider who worked with AYAs with metastatic cancer was eligible. Researchers with expertise in qualitative methods conducted inductive thematic content analysis of transcribed interviews. The analyzed data were used to formulate recommendations for clinicians.

RESULTS

Twelve AYA patients with self-reported stage IV cancer and five clinicians who care for AYAs with advanced stages of cancer were enrolled and shared their experience about AYA medical decision-making. Four primary themes emerged: (1) AYAs describe receiving unclear prognosis, (2) AYAs balance concepts of hope and risk, (3) AYAs choose aggressive treatment options, and (4) AYAs want support facing mortality. Recommendations for clinicians include clear communication about prognosis and side effects and concerted efforts to elicit patient values.

CONCLUSION

AYA patients and clinicians provided insights into the experiences and decision-making processes of AYA patients choosing to continue or discontinue treatment and into the areas for improvement in patient-centered oncology care. Taken together, these data provide important suggestions for clinicians caring for this vulnerable population.

Developmental considerations of young people with cancer transitioning to adulthood

The literature concerning the impact of having cancer during adolescence and emerging adulthood has been widely discussed in relation to the unique nature of psychosocial challenges. The current study presents these findings within the context of developmental literature to further our understanding on how their developmental transitioning can be affected by having cancer. Specifically, two developmental milestones considered to be the pre-requisites for acquiring an adult status were focused on: forming identity and establishing independence. Several traditions of developmental literature were incorporated, including the psychosocial, sociological and psychoanalytical perspectives. The study discusses challenges to these developmental processes and suggests measures to foster young people's normative development.

'I know I'm not invincible': An interpretative phenomenological analysis of thyroid cancer in young people

Objective

Thyroid cancer is one of the most common cancers affecting young people and carries an excellent prognosis. Little is known about the psychosocial issues that face young people diagnosed with a treatable cancer. This study explored how young people experienced diagnosis, treatment, and how they made sense of an experience which challenged their views on what it means to have cancer.

Method

Semi‐structured interviews were conducted with eight young people diagnosed with either papillary or follicular thyroid cancer, and analysed with interpretative phenomenological analysis (IPA).

Results

Two inter‐related aspects of their experience are discussed: (1) the range of feelings and emotions experienced including feeling disregarded, vulnerability, shock and isolation; (2) how they made sense of and ascribed meaning to their experience in the light of the unique nature of their cancer. A thread running throughout the findings highlights that this was a disruptive biographical experience.

Conclusions

Young people experienced a loss of youthful immunity which contrasted with a sense of growth and shift in life perspective. Having a highly treatable cancer was helpful in aiding them to reframe their situation positively but at the same time left them feeling dismissed over a lack of recognition that they had cancer. The young peoples’ experiences point to a need for increased understanding of this rare cancer, more effective communication from health care professionals and a greater understanding of the experiential impact of this disease on young people. Suggestions to improve the service provision to this patient group are provided.

Using poetry to explore normalcy as a coping mechanism for young people with cystic fibrosis

Living with chronic illness can lead to a spiral of losses including social capital, mobility, physical health and self-worth. One method of coping with a long-term condition is normalcy: psychological bracketing of the illness as a means of coping, and may include the embodiment of treatment as part of the norm. This paper explores the concept of normalcy in young people with cystic fibrosis, disseminated through poetry. The theme of normalcy emerged in a study exploring the experiences of young ‘expert patients’ in partnership with their healthcare team. Observations of outpatient consultations between 10 young people with cystic fibrosis (CF), two carers and the CF team ( n = 11) and subsequent interviews were undertaken to explore perceptions of partnership. Once findings emerged from the original study these were recrafted into poems as an alternative means of dissemination. The poetry from ‘what’s in a norm?’ reflects the young people’s voices and the writer’s interpretation of how normalcy has become embedded into their ways of being. Minimising the impact of CF in this sample was commonplace. Normalcy as a concept emerged strongly in young people with CF in this study. Almost exclusively young people viewed the range of treatments and symptoms as not significant. Further probing revealed a very different picture, one of heavy treatment burden and symptom management. Normalcy may serve as a positive means of coping with the burden of disease. Dissemination of research findings through poetry can enhance nurses’ empathic understanding and provide holistic interpretation of events rather than just summative findings.

Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer

PURPOSE

For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment.

METHODS

MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted.

RESULTS

166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life.

CONCLUSION

The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.

Articulating a Patient-Centered Design Space for Cancer Journeys

Cancer journeys, encompassing patients' cancer experiences through survivorship, are complex and diverse. Individuals must cope with numerous physical and emotional challenges, balancing clinical tasks alongside responsibilities of daily life. Understanding the breadth of factors that contribute to a patient's cancer experience presents a critical challenge in developing holistic patient-centered technology. To further our understanding of the cancer journey, we conducted focus groups and interviews with 31 breast cancer patients. We present a cancer journey framework depicting the responsibilities, challenges, and personal impacts patients face while transitioning from diagnosis through post-treatment survivorship. Through this work, we aim to aid the development of health tools that consider a patient's cancer journey and health needs more broadly, supporting patient's health management alongside the complexities and priorities of daily life.

Normative Social Support in Young Adult Cancer Survivors

Following a cancer diagnosis, young adults (YAs; that is, 18-39) often experience altered social relationships with family, friends, romantic partners, and peers. In light of the social struggles YA patients and survivors report due to cancer's biographical disruption, we elicited narratives from 30 YA cancer survivors to examine how their normative perceptions of social support functioned to hinder and assist them in coping with the cancer experience. Through thematic narrative analysis of their individual accounts, YA survivors explained why and how they perceived various support attempts from peers and loved ones to be effective (i.e., being treated "normally"), ineffective (i.e., receiving pity, negative stories, rudeness, excessive self-monitoring, and returns from estrangement), and both effective and ineffective (e.g., instrumental and relational support) in integrating cancer into their biographies. Implications for the advancement of interpersonal communication theory and for the development of age-appropriate communication interventions, educational programs, and informational resources are discussed.

Psychosocial outcomes and interventions among cancer survivors diagnosed during adolescence and young adulthood (AYA): a systematic review

PURPOSE

A cancer diagnosis during adolescence or young adulthood (AYA; defined as ages 15-39) generates unique medical and psychosocial needs as developmental milestones are simultaneously impacted. Past research highlights that AYAs' experiences and psychosocial outcomes are different, and more research and attention is needed. We aimed to identify and synthesize literature regarding psychosocial outcomes, unique needs, and existing psychosocial interventions pertaining to individuals diagnosed with cancer exclusively during AYA, and to highlight areas for future research.

METHODS

A systematic literature search was conducted using MEDLINE (via PubMed), EMBASE, Cochrane, Web of Science, and PsycINFO (via OVID). Grey literature was searched using key term variations and combinations. Overall, 15,301 records were assessed by two independent reviewers, with 38 studies meeting inclusion criteria.

RESULTS

Data synthesis of the 38 articles was organized by four main themes based on quality of life and survivorship: physical well-being (7 studies), psychological well-being (8 studies), social well-being (9 studies), and survivorship care (14 studies). The paucity of studies for such broad inclusion criteria highlights that this population is often combined or subsumed under other age groups, missing needs unique to these AYAs.

CONCLUSIONS

AYA cancer survivors' experiences are nuanced, with interacting variables contributing to post-treatment outcomes. AYAs require age-appropriate and flexible care, informational needs and treatment-related education that foster autonomy for long-term survivorship, as well as improved follow-up care and psychological outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

By incorporating these findings into practice, the informational and unmet needs of AYAs can be addressed effectively. Education and programming is lacking specific and general subject matter specific to AYAs, incorporating ranging needs at different treatment stages.

Patient-provider communication about the emotional cues and concerns of adolescent and young adult patients and their family members when receiving a diagnosis of cancer

OBJECTIVE

This study aimed to examine how emotional cues/concerns are expressed and responded to in medical consultations with adolescent and young adults (AYA), an understudied patient group, at the time of cancer diagnosis.

METHODS

Nine consultations in which AYA patients aged 12-25 years were informed about their cancer diagnosis and treatment plans were audio recorded. Expressions of emotional cues/concerns and physicians' responses were identified and coded using The Verona Coding Definitions of Emotional Sequences (VR-CoDES).

RESULTS

A total of 135 emotional cues/concerns (range: 2-26, median: 13) were identified. Cues or concerns that were expressed by patients and relatives following questions from physicians were more often explicit than patient-initiated cues/concerns. Questions about medical and practical issues could often be understood as ways of expressing emotional cues. When patients or relatives expressed less explicit verbal cues about underlying concerns, physicians often responded by presenting medical information without commenting on the emotional aspect indicated by the cue.

CONCLUSION

The communication was dominated by information-giving, but the questions from patients and relatives and their responses to the information often had emotional connotations.

PRACTICE IMPLICATIONS

Patients' requests for information may include an emotional aspect. These preliminary findings should be tested in a larger sample.

Understanding the experiences of adolescents and young adults with cancer: A meta-synthesis

PURPOSE

To conduct a meta-synthesis of qualitative studies exploring experiences of young cancer patients to identify the overarching concepts that inform future service and research directions.

METHOD

A systematic literature search was conducted, and 51 articles published between January 2004 and March 2014 were collected via CINAHL, Medline and PsycINFO databases. Deductive thematic analysis was conducted to identify major themes, guided by Hermeneutic notions on interpretation.

RESULTS

Cancer impacted a wide range of life domains. These impacts were interconnected and bi-directional. The meanings of these impacts were closely related to their unique developmental needs and a social position as youth. Emotional struggles during these radical changes were evident, but efforts to make sense of their experiences and find meaning pervaded.

CONCLUSIONS

Given the interrelated nature of the cancer challenges young cancer patients experience, there needs to be an emphasis on conducting studies which further refine our understanding of these relationships. This can help to structure effective youth cancer services. Generic informational resources and support services should be tailored so that they have relevance to the young person's life context. The treating team has an important role in fostering young patients' ability to make sense of their experiences by providing developmentally-relevant psychosocial support.

Tailoring the delivery of cancer diagnosis to adolescent and young adult patients displaying strong emotions: An observational study of two cases

Delivering the bad news of a cancer diagnosis to adolescent and young adult (AYA) patients who display strong emotions is particularly challenging not the least because AYAs are at a vulnerable developmental stage. Due to the lack of research on how to personalize the delivery of bad news to AYA patients’ emotions we report a case study of the communicative behavior of oncologists in two such consultations to describe the complexity of the phenomena at study. We audio-recorded and transcribed consultations where oncologists delivered cancer diagnoses to nine AYAs aged 12–25 years. Two of these patients displayed particularly strong emotional behavior (anger, fear, and sadness) and were chosen as cases. An interpretative analysis in three steps was applied to investigate the oncologists’ communicative behavior when delivering bad news. The focus was on how the oncologists responded to the strong but different emotional behaviors of the AYAs. We also related the oncologists’ communicative behavior to elements from a widely used protocol for delivering bad news. We found that the oncologists applied five communication strategies: elicit patient perspective, provide information, respond to patient's expression of emotion (acknowledging and containing emotions), encourage commitment to treatment, and provide hope. The findings illustrate how oncologists’ communicative behavior may be tailored to individual expressions of emotions in AYA cancer patients.

The existential cancer journey: Travelling through the intersubjective structure of homeworld/alienworld

In the past couple of decades, there has been significant interest in the research literature and patient narratives that focus on describing the cancer journey as involving existential and spiritual transformative experiences. The purpose of this article is to contribute with a new and deepened understanding of the existing literature by offering a philosophical informed analytic conceptualization that highlights the ‘liminal’, transformative and ‘generative’ dimension of the cancer journey. For that purpose, qualitative data drawn from a qualitative study investigating existential experiences of a group of Danish patients in rehabilitation were analysed employing the American phenomenologist Anthony J. Steinbock’s interpretation of the Husserlian concepts homeworld/alienworld ( Heimwelt/Fremdwelt). Data used in this article derived from qualitative interviews (11 individual interviews and 9 focus group interviews) with cancer patients participating in rehabilitation week courses at a Danish rehabilitation centre. The analysis led to the development of three themes: ‘The heavy break with the homeworld’, ‘Realizing a new homefellowship’ and ‘Transformation of the homeworld’. Findings suggest that journeying with cancer involves a ‘liminal’ experiencing of having to navigate in a borderless and unfamiliar territory between a homeworld and an alienworld before ultimately arriving at a sense of transformation in which meaning is derived from both lifeworlds. It is argued that such an understanding of the intersubjectivity between lifeworlds highlights the need for health care professionals communicating with patients throughout their cancer journey about whether and how the illness experiences have been integrated into their lifeworld and whether help is needed in order to achieve existential rehabilitation.

Working Toward Normalcy Post-Treatment: A Qualitative Study of Older Adult Breast and Prostate Cancer Survivors

PURPOSE/OBJECTIVES

To develop a better understanding of how older adult survivors of early-stage breast and prostate cancer managed the work of recovery.
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RESEARCH APPROACH

Multiple case study design embedded in a larger randomized, controlled trial of a nurse-led patient navigation intervention. 
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SETTING

Community-based research conducted via in-home visits and by phone with participants residing in non-metropolitan areas of a mid-Atlantic state.


PARTICIPANTS

Rural-dwelling adults aged 60 years or older with early-stage breast or prostate cancer and the people who support them (11 dyads).


METHODOLOGIC APPROACH

An approach to grounded theory analysis was used to evaluate the fit between existing theoretical knowledge and case findings and to generate new knowledge about the cancer recovery process.


FINDINGS

Working toward normalcy was a core process of cancer recovery prompted by participants' internal experiences and external interactions with their environments. This ongoing, iterative, and active process involved multiple concurrent strategies that were not necessarily medically oriented or cancer specific. Working toward normalcy resulted in movement along a continuum of self-appraisal anchored between participants experiencing life as completely disrupted by cancer to a life back to normal. A greater sense of normalcy was associated with higher engagement in valued activities and increased physical and psychological well-being.


CONCLUSIONS

In addition to the core process of working toward normalcy, multiple theories from nursing, sociology, psychology, and gerontology helped to explain case findings. This knowledge could serve as a foundation on which to design survivorship care that supports the goals of cancer survivors working toward normalcy post-treatment.

INTERPRETATION

Post-treatment wellness goals can include a desire to reestablish or maintain a sense of normalcy. Nursing actions that promote survivors' efforts to be perceived as capable, stay engaged in valued activities and roles, maintain a sense of control over their lives and bodies, and make plans for the future may help meet this goal. Existing theories about identity, dignity, inner strength, and the work of illness can inform nursing interventions. 


Family members' retrospective stories of the treatment stage of an adolescent or young adult who subsequently died of cancer

BACKGROUND

Adolescents and young adults (AYAs) with cancer have been recognized as being disadvantaged within the present healthcare system. This article is part of a major study that was motivated by the principal researcher's own experience of her 17-year-old son dying of cancer and from current literature that highlights the lack of support and understanding of AYAs and their families.

OBJECTIVE

This article aimed to uncover from the stories of family members the experience after the treatment of an adolescent or young adult family member (aged 13-23 years) who subsequently died.

METHODS

Narrative inquiry was determined to be the appropriate methodology for this study. The participants were a self-selected purposeful sample of 26 family members whose narratives spoke of experience of having an AYA family member live with and die of cancer.

RESULTS

The meta-narrative of the families' stories in the treatment stage resulted in 6 themes. This article provides the insights of experience of the family members within the treatment stage. The family members speak of a health system unable to respond to the AYA and family member's needs and the suffering sacrifice and courage of the AYAs and the family members.

CONCLUSION

There is evidence that AYAs and family members are lost in the system, with minimum understanding or support for this unique group of people.

IMPLICATIONS FOR PRACTICE

Further research is required to assist the development of evidence-based best practice models of care for AYAs and their families.

The reality of hospitalisation: stories from family members of their hospital experience for adolescents and young adults living with and dying from cancer

BACKGROUND

Adolescents and Young Adults (AYAs) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues.

OBJECTIVE

A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation.

METHODS

Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8.

RESULTS

In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation'. Within this theme issues regarding: The place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed.

CONCLUSION

While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolescents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.

It's the "good" cancer, so who cares? Perceived lack of support among young thyroid cancer survivors

PURPOSE/OBJECTIVES

To describe the survivorship experience of young adult patients with thyroid cancer.

RESEARCH APPROACH

A qualitative, descriptive study.

SETTING

Four Canadian provinces, with most participants from Ontario.

PARTICIPANTS

12 young adult thyroid cancer survivors who participated in a larger study on follow-up care needs consisting of 55 young adult cancer survivors.

METHODOLOGIC APPROACH

Telephone interviews were conducted with cancer survivors who were diagnosed from age 18-39 years and were 1-5 years post-treatment.

FINDINGS

All 12 thyroid cancer survivors discussed the feeling that their cancer experiences often were downplayed because thyroid cancer is labeled as the "good" cancer. Many said that they were not considered real patients with cancer by healthcare providers and other patients with cancer, and they were unable or unwilling to access support programs or assistance from healthcare providers.

CONCLUSIONS

Cancer can have an impact on a person's life regardless of the prognosis. Being diagnosed with thyroid cancer at a young age can pose additional challenges because of the lack of available support to address needs specific to young adults.

INTERPRETATION

Healthcare providers must recognize the needs of thyroid cancer survivors and encourage them to access supportive services.

KNOWLEDGE TRANSLATION

Patients with thyroid cancer believe that their needs often are overlooked because of high survival rates, and they have difficulty accessing support resources and finding help. Young adults with cancer often have unique support needs. Support needs may not be the same for all young adult patients with cancer, and those needs should be recognized and addressed.

Dating, marriage, and parenthood for HIV-positive heterosexual Puerto Rican men: normalizing perspectives on everyday life with HIV

HIV-positive men are living long and healthier lives while managing HIV as a chronic illness. Although research has extensively documented the experiences of illness of people living with HIV, dating, marriage, and fatherhood among heterosexual Latino men has not been examined. To address this gap, this study used a qualitative study design to examine patterns and strategies for dating, marriage, and parenthood among 24 HIV-positive heterosexual Puerto Rican men living in Boston. The findings in our study indicate that an HIV diagnosis does not necessarily deter men from having an active sexual life, marrying, or having children. In fact, for some of the men, engaging in these social and life-changing events is part of moving on and normalizing life with HIV; these men planned for, achieved, and interpreted these events in the context of establishing normalcy with HIV. Although the HIV diagnosis discouraged some men from engaging in sexual relations, getting married, or having children, others fulfilled these desires with strategies aimed to reconciling their HIV status in their personal life, including dating or marrying HIV-positive women only. Additional important themes identified in this study include the decision to disclose HIV status to new sexual partners as well as the decision to accept the risk of HIV transmission to a child or partner in order to fulfill desires of fatherhood. Understanding the personal struggles, decision-making patterns, and needs of HIV-positive heterosexual men can aid in designing interventions that support healthy living with HIV.

"Cancer sucks," and other ponderings by adolescent and young adult cancer survivors

As part of the National Cancer Institute's AYA HOPE study, 296 adolescent and young adults (AYAs) completed an open-ended survey item asking them to describe their medical care or experience with cancer. Patient, provider, and system-level characteristics all appear to influence AYAs' perceptions of their medical care. Participants attributed levels of satisfaction with care to the availability and communication of information, the management of side-effects, and the expediency and flexibility of treatments. Struggles with health insurance and finances were evident. Findings contribute to a better understanding of AYAs' cancer treatment experiences and will inform improvements to oncology care for this population.

The reality of hospitalisation: Stories from family members of their hospital experience for adolescents and young adults living with and dying from cancer

Abstract Background: Adolescents and Young Adults (AYA) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues Objective: A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation Methods: Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8. Results: In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation.' Within this theme issues regarding: the place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed. Conclusion: While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolelscents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.

Distress and adjustment among adolescents and young adults with cancer: an empirical and conceptual review

Adolescents and young adults (AYAs) with cancer must simultaneously navigate the challenges associated with their cancer experience, whilst striving to achieve a number of important developmental milestones at the cusp of adulthood. The disruption caused by their cancer experience at this critical life-stage is assumed to be responsible for significant distress among AYAs living with cancer. The quality and severity of psychological outcomes among AYAs remain poorly documented, however. This review examined the existing literature on psychological outcomes among AYAs living with cancer. All psychological outcomes (both distress and positive adjustment) were included, and AYAs were included across the cancer trajectory, ranging from newly-diagnosed patients, to long-term cancer survivors. Four key research questions were addressed. Section 1 answered the question, "What is the nature and prevalence of distress (and other psychological outcomes) among AYAs living with cancer?" and documented rates of clinical distress, as well as evidence for the trajectory of this distress over time. Section 2 examined the individual, cancer/treatment-related and socio-demographic factors that have been identified as predictors of these outcomes in this existing literature. Section 3 examined current theoretical models relevant to explaining psychological outcomes among AYAs, including developmental models, socio-cognitive and family-systems models, stress-coping frameworks, and cognitive appraisal models (including trauma and meaning making models). The mechanisms implicated in each model were discussed, as was the existing evidence for each model. Converging evidence implicating the potential role of autobiographical memory and future thinking systems in how AYAs process and integrate their cancer experience into their current sense of self and future goals are highlighted. Finally, Section 4 addressed the future of psycho-oncology in understanding and conceptualizing psychological outcomes among AYAs living with cancer, by discussing recent empirical advancements in adjacent, non-oncology fields that might improve our understanding of psychological outcomes in AYAs living with cancer. Included in these were models of memory and future thinking drawn from the broader psychology literature that identify important mechanisms involved in adjustment, as well as experimental paradigms for the study of these mechanisms within analogue, non-cancer AYA samples.