Grief and Life Disruption in Young Adults with Advanced Cancer

The Experiences of Young Adults Living with Metastatic/Advanced Cancer: A Scoping Review

There is limited research on young adults (YAs) living with cancer and even less concerning those with metastatic/advanced disease. The purpose of this scoping review was to map and summarize the current state of empirical research on the psychosocial experiences of YAs living with metastatic/advanced cancer, highlighting gaps in the published literature. This study was guided by Arksey and O'Malley's scoping review methodology. MEDLINE, CINAHL, and PsycINFO were searched in consultation with a medical research librarian, for English-language articles published until June 2018. Three key journals were hand-searched along with the first 100 hits on Google Scholar. In addition, ProQuest Dissertations and Theses was searched for dissertations published until February 2018. Two authors independently screened titles/abstracts to identify articles for full text review. Data were extracted on study characteristics and outcomes related to the guiding review question. Thematic analysis was used to analyze the data and identify overarching themes. Summary statistics were reported. The search strategy retrieved 2846 published articles. After reviewing 47 in full text, 10 studies were eligible for inclusion. The results from the included studies fell into four themes: (1) search to make meaning of their illness; (2) patient-provider relationships; (3) mental health and psychosocial well-being; and (4) interventions. Research concerning the psychosocial experiences of YAs living with metastatic/advanced cancer is limited. The authors provide four recommendations as a starting point for further research. Understanding the patient experience is imperative for designing effective health policies, programs, and interventions for this population.

Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies

Adolescents and young adults (AYAs) occupy a unique place within the hematologic malignancy community due to the challenges they face related to their disease biology and physical, psychosocial, and economic circumstances, as well as issues related to access to care and long-term follow-up. Efforts to define age-specific (supportive) care needs and targets for intervention in these areas are evolving. This review discusses the psychosocial issues AYAs with hematologic malignancies are dealing with, how these might affect their health-related quality of life, and the challenges in delivering high-quality supportive care to this underserved population.

The bereavement experience of adolescents and early young adults with cancer: Peer and parental loss due to death is associated with increased risk of adverse psychological outcomes

BACKGROUND

Adolescents commonly experience loss due to death, and perceived closeness to the deceased can often increase the intensity of bereavement. Adolescents and early young adult (AeYA) oncology patients may recall previous losses or experience new losses, possibly of other children with cancer, while coping with their own increased risk of mortality. The bereavement experiences of AeYA patients are not well described in the literature.

METHODS AND FINDINGS

This analysis of bereavement sought to describe the prevalence and types of losses, the support following a death, and the impact of loss on AeYAs aged 13-21 years with malignant disease (or a hematologic disorder requiring allogeneic transplant). Participants were receiving active oncologic therapy or had completed therapy within the past 3 years. Participants completed a bereavement questionnaire and inventories on depression, anxiety, and somatization. The cross-sectional study enrolled 153 AeYAs (95% participation), most (88%) of whom had experienced a loss due to death. The most commonly reported losses were of a grandparent (58%) or friend (37%). Peer deaths were predominantly cancer related (66%). Many participants (39%) self-identified a loss as "very significant." As loss significance increased, AeYAs were more likely to report that it had changed their life "a lot/enormously" (P<0.0001), that they were grieving "slowly or never got over it" (P<0.0001), and that they felt a need for more professional help (P = 0.026). Peer loss was associated with increased risk of adverse psychological outcomes (P = 0.029), as was parental loss (P = 0.018).

CONCLUSIONS

Most AeYAs with serious illness experience the grief process as slow or ongoing. Peer or parental loss was associated with increased risk of negative mental health outcomes. Given the high prevalence of peer loss, screening for bereavement problems is warranted in AeYAs with cancer, and further research on grief and bereavement is needed in AeYAs with serious illness.

Supporting adolescents and young adults with cancer through transitions: position statement from the Canadian Task Force on Adolescents and Young Adults with cancer

OBJECTIVE

This position statement from the Canadian Task Force on Adolescents and Young Adults with cancer aims to (1) conceptualize the numerous transition experiences encountered by adolescents and young adults (AYA) with cancer; and (2) provide recommendations on how to help the AYA regain a sense of control over their lives as they adjust to these transition experiences.

METHODS

We reviewed and synthesized a heterogeneous sample of studies and recommendations, ranging from well-designed case-controlled investigations to opinions of respected authorities based on clinical experience, and reports of expert committees.

RESULTS

We describe the key factors that have an impact on different transitions during the cancer journey, and the need for developmentally appropriate services for AYA with cancer that consider both the system issues and individual transition issues. Our recommendations are not intended to be prescriptive, but they are broad enough to be applicable in different types of settings (eg, family doctor, cancer center, specialty service) and systems beyond health care (eg, school system, social system).

CONCLUSIONS

The Task Force urges health care providers, parents, and AYA with cancer to work together in planning and implementing strategies that will enable individuals to navigate the transitions they encounter along the cancer journey successfully, and strive for meaningful participation in life situations, achieving their potential as fully functional members of society.

Patient-oncologist alliance, psychosocial well-being, and treatment adherence among young adults with advanced cancer

PURPOSE

Patients who develop a strong alliance with their health care providers have been shown to have higher levels of psychosocial well-being and rates of treatment adherence. Young adults with cancer have lower levels of psychosocial well-being and treatment adherence relative to patients with cancer in other age groups. This study sought to evaluate the relationships between the patient-oncologist alliance, psychosocial well-being, and treatment adherence in young adults with advanced cancer.

PATIENTS AND METHODS

Ninety-five young adults (age 20 to 40 years) with advanced cancer were administered measures of alliance, psychosocial well-being, willingness to adhere to treatment, and treatment adherence. Relationships between alliance and psychosocial well-being were examined bivariately. Multiple linear regression models examined the relationship between alliance and adherence, controlling for confounding influences (eg, psychosocial well-being).

RESULTS

Alliance was significantly (P ≤ .01) and positively associated with greater perceived social support and less severe illness-related grief. After controlling for significant confounding influences (ie, metastases, appraised support, and grief), alliance remained significantly (P ≤ .01) associated with greater willingness to adhere to treatment and greater adherence to oral medication.

CONCLUSION

By developing a strong alliance, oncologists may enhance psychosocial well-being and increase treatment adherence in young adult patients with advanced cancer.