Adolescent and Young Adult Patients with Cancer: Perceptions of Care

How Do Adolescent and Young Adult Patients with Cancer Manage Their Chemotherapy-Related Symptoms at Home?

Chemotherapy can cause many distressing side effects, potentially impacting treatment completion and quality of life in adolescent and young adult (AYA) patients with cancer. To identify ways to help mitigate chemotherapy-related symptoms, we sought to elicit barriers and facilitators to managing symptoms experienced by AYAs with cancer through interviews. Qualitative thematic analysis identified three main domains: (1) managing chemotherapy symptoms (e.g., medication, home remedies), (2) anticipating and mitigating symptoms (e.g., management of symptoms at home, anticipatory guidance), and (3) knowing when to seek care (e.g., unexpected and unusual symptoms). This study elucidated that AYAs can successfully manage symptoms at home when given the proper guidance and this could be a focus of future efforts to improve outcomes in this population. The Clinical Trial Registration number is NCT04594096.

The Place of Sick Peers in Adolescents and Young Adults with Cancer: Advantage, Disadvantage, and What Makes Barriers to the Encounter

Purpose: The appreciation of peer support can vary from one country to another due to the cultural and relational differences. This study explores what perceptions French adolescents and young adults (AYAs) in post-treatment for cancer have of the place of sick peers during their treatment and what can make barriers to meet them. Methods: A semistructured interview has been proposed 6 months after the end of cancer treatments. A thematic analysis has been conducted to highlight the major themes and subthemes identified through the participants' discourses. Results: Twelve AYAs (mean age 23 y.o., standard deviation = 2.8; min = 19; max = 26) from two French cancer centers were interviewed. Five major themes were identified, but only two were presented in this article: the place of peers and the impact of coronavirus disease 2019 (COVID-19) epidemic on AYA facilities. AYA peers with cancer major theme demonstrated that meeting sick peers has benefits (e.g., identification, understanding, support, feeling of normalcy) but also has disadvantages (e.g., negative emotional influence). The benefits of peer-to-peer meetings seem to outweigh the disadvantages. Nevertheless, AYAs can face social barriers to this kind of relationship (e.g., fatigue, need to focus on oneself, confrontation to cancer and negative events, feeling of unnatural meeting). Finally, patients' encounters and the normal functioning of AYA facilities have been hampered by the COVID-19 pandemic. Conclusion: Even if AYA services systematically suggest a meeting with other sick peers, it is important to reiterate this proposal since the needs can evolve over time. It can also be interesting to propose places of life outside the hospital to make the encounters more comfortable and natural for AYAs. Clinical Trial Registration number: NCT03964116.

Palliative Care Nursing Case Management in Young Adults With Advanced Rare Cancer: Case Discussion of a Multidisciplinary Approach

Purpose/Objectives:

This case aims to identify the elements of care continuity that are lacking in young adult patients with advanced rare cancer, suggesting ways to enhance continuity of care through nurse case manager/management (NCM) interventions and describing their impact on the emotional burden of patients and their families.

Primary Practice Setting(s):

Comprehensive cancer center.

Findings/Conclusions:

The dyadic care alliance with the NCM can alleviate disease burden, fostering trust in the team and adherence to care advice, thus reducing the patient's distress. The NCM can be an efficient option to advocate for patient needs on the multidisciplinary team, addressing practical issues and the unmet needs of patients and their caregivers, and facilitating referrals to other professionals. The study also shows that caring for young adults with advanced rare cancers should include mindful evaluation of their significant others.

Implications for Case Management Practice:

The Lived Experience of Young Adult Cancer Survivors after Treatment: A Qualitative Study

OBJECTIVE

The purpose of this qualitative study was to compare the lived experiences among extended (one year or less post-treatment) and long-term (three years or more post-treatment) young adult (YA) cancer survivors (ages 18-39 years old).

METHODS

Two trained researchers conducted semi-structured interviews inquiring about the overall lived experience of N = 24 YA cancer survivors (n = 12 extended and n = 12 long-term). The same two researchers independently completed line-by-line coding and thematic content analysis.

RESULTS

Interviews lasted an average of 41 min and revealed common themes of symptoms, psychosocial concerns, coping, and changes in health behaviors (e.g., nutrition and physical activity). All participants discussed symptoms impairing their quality of life and affecting their fear of recurrence. Specific psychosocial concerns among extended survivors were appearance-related (e.g., hair loss, weight gain) whereas concerns among long-term survivors included job loss, fertility, and financial stress. Coping strategies described by extended survivors were often distraction-based (e.g., watching television to "escape"), while long-term survivors described more active coping strategies (e.g., yoga, meditation, and seeking support from family and friends). Most survivors reflected on limited physical activity or unhealthy eating during treatment; however, nearly all declared healthy eating and physical activity post-treatment to improve well-being.

CONCLUSIONS

YA cancer survivors report differing symptoms, psychosocial concerns, and coping strategies across time since treatment. While survivors reported challenges with physical activity and nutrition during treatment, nearly all emphasized the importance of these health behaviors post-treatment. Thus, health behavior interventions could represent a preferred approach to address post-treatment challenges and improve quality of life for YA survivors.

The Adolescent and Young Adult Needs Assessment & Service Bridge (NA-SB): A single-arm feasibility pilot study

PURPOSE

In this pilot study, we evaluated the feasibility of implementing the Needs Assessment & Service Bridge (NA-SB)- an intervention to address the pervasive unmet needs of adolescents and young adults (AYAs) during cancer treatment.

METHODS

We conducted a mixed methods single-arm feasibility pilot study of NA-SB at the North Carolina Basnight Cancer Hospital. Eligible participants were AYAs ages 18-39 in active cancer treatment. After receiving NA-SB, participants completed a postintervention survey assessing their perceptions of NA-SB. We interviewed participating providers to assess their implementation experiences.

RESULTS

On average, AYA participants (n = 26) rated NA-SB's feasibility as 4.5/5, its acceptability as 4.5/5, and its appropriateness as 4.4/5. 77% of participants agreed or strongly agreed that their needs were met in the study period.

CONCLUSION

This pilot study generated preliminary evidence to establish NA-SB's feasibility as well as proof of concept for the intervention as a viable approach for identifying and addressing AYAs' unmet needs.

Reported Mental Health, Diet, and Physical Activity in Young Adult Cancer Survivors

Young adult (YA) cancer survivors are at increased risk for chronic diseases and face age-dependent stressors that may hinder their ability to maintain healthy lifestyle behaviors. This study examined associations between reported mental health, eating beliefs, and health behaviors in YA cancer survivors. YA cancer survivors aged 18-39 years (n = 225) completed a self-administered REDCap^® survey, including the Perceived Stress Scale 10, PROMIS^® Anxiety and Depression, Eating Beliefs Questionnaire, National Health and Nutrition Examination Survey Dietary Screener Questionnaire, Godin-Shephard Leisure-Time Physical Activity Questionnaire, and demographic and diagnosis-related questions. Descriptive statistics, bivariate analyses, and multiple linear regression were performed. Participants were mean 31.3 years old and 3.7 years post-treatment; 77.3% were women. Most participants reported White (78%) or Black or African American (11.2%) race and non-Hispanic ethnicity (84%). Adjusting for covariates, perceived stress, anxiety, and depression were associated with increased added sugar intake (p < 0.001) and eating beliefs (p < 0.001). Perceived stress and depression were associated with reduced vegetable intake (p < 0.05). There were no associations with fruit intake or physical activity in the adjusted models. Health behavior interventions for this population may address psychosocial needs by including a stress management or mind-body component. Further research including direct measures of health behaviors is warranted.

Early Psychosocial Contact for Adolescents and Young Adults (AYAs) with Cancer: The Impact of the AYA Oncology Navigator

This retrospective chart review assesses the impact of introduction of an adolescent young adult oncology navigator (AYAON) on first contact with oncology psychosocial services (OPS) for adolescents and young adults (AYAs) newly diagnosed with cancer. All AYAs newly diagnosed at a single adult oncology center between 17 and 29 years of age from July 2016 to July 2018 were reviewed. AYA contact with the AYAON was associated with an increase in contact with OPS. Following the introduction of the AYAON, there was a clinically significant decrease in the time to first OPS contact for newly diagnosed AYAs with cancer.

An actionable needs assessment for adolescents and young adults with cancer: the AYA Needs Assessment & Service Bridge (NA-SB)

PURPOSE

In the USA, many of the nearly 90,000 adolescents and young adults (AYAs) diagnosed with cancer each year do not receive services to address the full scope of needs they experience during and after cancer treatment. To facilitate a systematic and patient-centered approach to delivering services to address the unmet needs of AYAs with cancer, we developed the AYA Needs Assessment & Service Bridge (NA-SB).

METHODS

To develop NA-SB, we leveraged user-centered design, an iterative process for intervention development based on prospective user (i.e., provider and AYA) engagement. Specifically, we conducted usability testing and concept mapping to refine an existing tool-the Cancer Needs Questionnaire-Young People-to promote its usability and usefulness in routine cancer practice.

RESULTS

Our user-centered design process yielded a need assessment which assesses AYAs' physical, psychosocial, and practical needs. Importantly, needs in the assessment are grouped by services expected to address them, creating an intuitive and actionable link between needs and services.

CONCLUSION

NA-SB has the potential to improve care coordination at the individual level by allowing cancer care programs to tailor service delivery and resource provision to the individual needs of AYAs they serve.

Understanding and Enhancing Support Group Participation Among Adolescent and Young Adult Cancer Survivors: The Impact of Integrating Adolescent and Young Adult Cancer Navigation Services

This quality improvement initiative aimed to (1) explore the impact of adolescent and young adult (AYA)-specific navigation on attendance at a monthly peer support group for survivors aged 18-39 at a large comprehensive cancer center, and (2) better understanding attendees' preferences for group structure. Group attendance significantly increased following integration of AYA navigation. Using an online survey, we identified priority topics for discussion and desired changes to group organization, leading to modifications to group structure. Results highlight the value of having dedicated staff who proactively orient patients to resources tailored to their unique needs, and the importance of flexible program development that incorporates stakeholder input.

Age-Specific Patient Navigation Preferences Among Adolescents and Young Adults with Cancer

BACKGROUND

Patient navigation is increasingly being directed at adolescent and young adult (AYA) patients. This study provides a novel description of differences in AYA cancer patients' preferences for navigation services by developmental age at diagnosis.

METHODS

Eligible patients were diagnosed with cancer between ages 15 and 39 and had completed at least 1 month of treatment. Between October 2015 and January 2016, patients completed semi-structured interviews about navigation preferences. Summary statistics of demographic and cancer characteristics were generated. Differences in patient navigation preferences were examined through qualitative analyses by developmental age at diagnosis.

RESULTS

AYAs were interviewed (adolescents 15-18 years N = 8; emerging adults 19-25 years N = 8; young adults 26-39 years N = 23). On average, participants were 4.5 years from diagnosis. All age groups were interested in face-to-face connection with a navigator and using multiple communication platforms (phone, text, email) to follow-up. Three of the most frequently cited needs were insurance, finances, and information. AYAs differed in support, healthcare, and resource preferences by developmental age; only adolescents preferred educational support. While all groups preferred financial and family support, the specific type of assistance (medical versus living expenses, partner/spouse, child, or parental assistance) varied by age group.

CONCLUSIONS

AYAs with cancer have different preferences for patient navigation by developmental age at diagnosis. AYAs are not a one-size-fits-all population, and navigation programs can better assist AYAs when services are targeted to appropriate developmental ages. Future research should examine fertility and navigation preferences by time since diagnosis. While some navigation needs to span the AYA age range, other needs are specific to developmental age.

Provider perceptions' of a patient navigator for adolescents and young adults with cancer

PURPOSE

Healthcare providers (HCPs) and other staff at a comprehensive Cancer Center were interviewed on how to best implement a patient navigator position when working with adolescents and young adults (AYA) with cancer. Research objectives included assessing staff perceptions of (a) barriers to optimal care for AYA, (b) roles and responsibilities for a patient navigator, and (c) training needed for future patient navigators.

METHODS

Semi-structured interviews were conducted with 17 staff members providing care to AYA. Verbatim transcripts were hand-coded using inductive content analysis.

RESULTS

Roles and responsibilities of a patient navigator were described as needing to coordinate services, be knowledgeable of resources inside and outside the Cancer Center, provide emotional support, advocate for AYA, assist with financial and insurance issues, and serving as the first point of contact.

CONCLUSIONS

Staff serving AYA reported the desired roles and training they wished a patient navigator to possess. This study contributes to the literature by conducting stakeholder assessment of the goals and roles of an AYA patient navigator (PN). PN positions should be adapted to the workflow and ethos of the institution.