Psychological Outcomes in Adolescent and Young Adult Cancer Survivors

Psychological Distress and Problems Among Young and Middle-Aged Cancer Patients Undergoing Treatment in China

OBJECTIVE

Influenced by their life stage and socio-cultural background, young and middle-aged cancer patients in China may experience unique psychological distress. Therefore, this study investigated the severity, problems, and associated factors of psychological distress among young and middle-aged cancer patients.

METHODS

We conducted a cross-sectional study on young and middle-aged cancer patients aged 18-59 who were treated at a radiotherapy center from February 2022 to September 2023. Participants' psychological distress severity and problems were measured using the Distress Thermometer and the Problem List. Binary logistic regression was used to identify sociodemographic and clinical factors, as well as PL items, associated with clinically significant psychological distress in young and middle-aged cancer patients.

RESULTS

Among the 510 participants, 102 (20.0%) had DT scores ≥ 4, reported an average of 3.36 ± 3.78 problems, and 360 (70.6%) reported at least one problem. The five most frequently reported problems were worry, no time and energy to take care of children/elderly people, memory loss/lack of concentration, appearance/shape, and work/school. Annual household income, self-reported loneliness, nervousness, loss of interest in daily activities, eating, and nausea were associated with DT scores ≥ 4.

CONCLUSIONS

One-fifth of young and middle-aged cancer patients experienced clinically significant psychological distress. Greater attention should be paid to patients with lower household incomes and those who self-report loneliness, nervousness, loss of interest in daily activities, eating, and nausea, providing targeted support to alleviate psychological distress.

Global burden and trends of testicular cancer in adolescents and young adults from 1990 to 2021, with predictions to 2035

Testicular cancer predominantly affects adolescents and young adults (AYAs) aged 15-39 years. This study analyzed the global, regional, and national burden of testicular cancer among AYAs (1990 to 2021). Data from the Global Burden of Disease study was used to calculate age-standardized rates of incidence (ASIR), prevalence (ASPR), and disability-adjusted life years (ASDR). Trends were assessed using the Joinpoint regression and Bayesian age-period-cohort models, with projections up to 2035. Results showed the global ASIR of 4.05 (95% CI: 3.80-4.35), ASPR of 31.05 (95% CI: 28.88-33.68), and ASDR of 24.82 (95% CI: 22.99-26.91) per 100,000 in 2021, respectively. From 1990 to 2021, ASIR and ASPR increased, while ASDR remained relatively stable. Significant geographical disparities were observed, with Europe and Latin America showing higher burdens compared to Asia and Africa. The 25-29 age group had the highest age-specific rate of incidence (5.58; 95% UI: 5.25-5.97) and disability-adjusted life years (34.09; 95% UI: 31.55-37.11) per 100,000, while the 30-34 age group had the highest age-specific prevalence rate (43.12; 95% UI: 40.51-46.56) per 100,000 in 2021. By 2035, the global numbers of incidence and prevalence cases were projected to increase, with DALYs and age-standardized rates declining. These findings are crucial for informing global strategies in testicular cancer prevention.

Optimization of a digital health intervention to enhance well-being among adolescent and young adult cancer survivors: Design and methods of the EMPOWER full factorial trial

Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations and have not been routinely tested in AYA survivors. We are optimizing a web-based positive skills intervention for AYA cancer survivors called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) by: (1) determining which intervention components have the strongest effects on well-being and (2) identifying demographic and individual difference variables that mediate and moderate EMPOWER's efficacy. EMPOWER is a five-session online intervention that teaches behavioral and cognitive skills for increasing psychological well-being. Guided by the Multiphase Optimization Strategy (MOST), we assign two levels (yes, no) to each of five intervention components (positive events, capitalizing, & gratitude; mindfulness; positive reappraisal; personal strengths & goal-setting; acts of kindness), allowing us to evaluate the effects of individual and combined intervention components on positive affect in a full factorial design. Post-treatment AYA cancer survivors (N = 352) are recruited from participating NCI-designated comprehensive cancer centers and randomized to one of 32 experimental conditions. Our primary outcome is positive affect; potential mediating and moderating variables include coping self-efficacy and emotional support, respectively. Upon trial completion, we will have an optimized, digital health intervention to enhance psychological well-being among AYA cancer survivors. EMPOWER will be scalable and primed for a large, multi-site trial among AYAs who would otherwise not have access to supportive care interventions to manage distress and enhance well-being.

Psychiatric disorders in patients with benign and malignant sinonasal tumors: a prospective cross-sectional study

Objective

To assess the prevalence of depression, anxiety, insomnia, and somatic symptom disorder (SSD) in patients with benign and malignant sinonasal tumors.

Materials and methods

Pretreatment patients with sinonasal tumors were prospectively recruited on the rhinology ward of a tertiary hospital from July 2021 to March 2022. The electronic questionnaire which contains the rhinological symptom scale, the 22-item Sinonasal Outcome Test (SNOT-22) Scale, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Insomnia Severity Index (ISI), and the Patient Health Questionnaire-15 (PHQ-15) was filled out by patients at admission. The associations between the scores of symptom/SNOT-22 and psychometric tests were assessed by the Pearson correlation coefficient (r) and simple linear regression. The receiver operating characteristic (ROC) analysis was used to evaluate the performance of the SNOT-22 score in predicting psychiatric disorders.

Results

Thirteen patients with benign sinonasal tumors and 15 patients with malignant sinonasal tumors were recruited. The benign and malignant groups did not differ significantly regarding symptomatology and mental wellbeing. Of the total patients, 9 were at risk of depression (PHQ-9 > 4), 10 were at risk of anxiety (GAD-7 > 4), 11 were at risk of insomnia (ISI > 7), and 11 were at risk of SSD (PHQ-15 > 4). The overall symptom, facial pain/pressure, postnasal drip, and SNOT-22 scores were positively associated with scores of psychometric tests. Patients with a high SNOT-22 score (>18) are likely to be affected by comorbid psychiatric disorders. When interpreting the results of this study, it should be noted that screening tools, not diagnostic tools, were used to identify psychiatric risk.

Conclusion

Depression, anxiety, insomnia, and SSD are prevalent in patients with sinonasal tumors. Otolaryngologists should have a low threshold to ask the patient about psychiatric symptoms, especially for patients with an SNOT-22 score > 18.

Providing Survivorship Care for a Young Adult With a History of Blood Cancer

Adolescents and young adults (AYAs) with a history of cancer are at an increased risk for late effects from their cancer treatment and have higher rates of long-term morbidity and mortality compared to their age-matched peers. As a result, this vulnerable population needs attentive follow-up care, end-organ surveillance, and secondary cancer screening; however, a history of cancer can often become buried on a problem list or not addressed at all. This case report illustrates an AYA survivor of classic Hodgkin lymphoma who relocates to a new city and establishes care with a new primary care provider (PCP). The PCP's awareness of a prior cancer diagnosis and the previous treatment regimen is a critical component in providing comprehensive care. In this case, the PCP's first step is to reach out and collaborate with oncology providers to gather an accurate treatment summary and then consult evidence-based guidelines to develop a plan of care. Based on the patient's previous treatment with chemotherapy adriamycin, bleomycin, vinblastine, and dacarbazine, the PCP orders recommended testing, reviews results, and provides subsequent counseling on health promotion and psychosocial wellness. This case illustrates strategies healthcare providers can use to provide coordinated, evidence-based care for AYA cancer survivors.

Suicide Deaths Among Adolescent and Young Adult Patients With Cancer

This cohort study evaluates differences in suicide death rates across age groups of adolescent and young adult patients with cancer over time in the US.

[Young Adult Cancer Patients (AYA): Preferences for Outpatient Psychosocial Care and Gender-Specific Differences - Results from the AYA-LE study]

OBJECTIVE OF THE STUDY

To investigate the importance of individual topics in outpatient care services and the preferences for their design from the perspective of young adults with cancer (AYA="adolescents and young adults") in Germany.

METHODOLOGY

A total of 514 AYAs aged 18-39 years were surveyed twice over a 12-month period (t1=immediately after acute treatment, t2=12 months post-treatment) regarding the importance and satisfaction with topics such as anxiety, the impact of the illness on partnerships/family and social environment, future perspectives, personal coping strategies, sexuality, and desire for children/fertility, as well as the types of care services. The subjective importance and satisfaction with the care topics and services were analyzed using variance and moderator analyses.

RESULTS

The most important topics for care services were future career prospects (M=3.22, SD=1.56), social impact (M=3.19, SD=1.54), and personal coping strategies (M=3.52, SD=1.46). The greatest dissatisfaction was noted in the areas of sexuality (M=2.01, SD=1.59) and desire for children/fertility (M=2.08, SD=1.72). At time t2, relaxation techniques (M=3.46, SD=1.36) and psychological counseling (M=3.43, SD=1.46) were the most desired care services. Female AYAs rated psychological counseling (F[1.199)=9.21, p=0.003), social counseling (F[1.221]=6.60, p=0.011), creative therapy options (F[1.219]=21.74, p<0.001), support groups (F[1.215]=4.29, p=0.040), patient education (F[1.210]=6.96, p=0.009), and relaxation techniques (F[1.194]=23.68, p<0.001) significantly more important than male AYAs.

CONCLUSIONS

The study highlighted several areas of dissatisfaction with the current outpatient care services for AYAs. The results demonstrate the need to incorporate cross-sex and gender-specific care preferences of AYAs to improve outpatient psychosocial care. A specific set of AYA-care services should be designed and implemented to address the aforementioned psychosocial topics, which include sexuality and the desire for children/fertility. It is also crucial for outpatient practice to raise awareness among the involved professional groups. Further research is required to gain a deeper understanding of sex differences.

Protocol of a Multisite Randomized Controlled Trial of Bright IDEAS-Young Adults: Problem-Solving Skills Training to Reduce Distress among Young Adults with Cancer

BACKGROUND

Young adults with cancer diagnosed between the ages of 18 to 39 are recognized as a vulnerable group with unique emotional, social, and practical needs that put them at risk of poor psychosocial outcomes and impaired health-related quality of life (HRQOL). This study describes the protocol of a randomized controlled trial to evaluate the efficacy of Bright IDEAS-Young Adults (Bright IDEAS-YA), a problem-solving skills training intervention, on psychosocial outcomes of young adults newly diagnosed with cancer.

METHODS

Bright IDEAS-YA is a two-arm, parallel, randomized controlled trial. Young adults are eligible if they are 18-39 years of age, within four months of a first cancer diagnosis, and receiving systemic therapy with life expectancy of at least six months. Participants are randomized 1:1 to Bright IDEAS-YA or enhanced usual care. Survey measures are completed at enrollment and 3, 6, 12, and 24 months. The primary endpoint will be the estimated change from baseline to 6 months in symptoms of depression, anxiety, and psychosocial HRQOL. The other time points are secondary endpoints. Mediators and moderators will be examined.

CONCLUSIONS

This randomized trial will determine the efficacy of Bright IDEAS-YA on psychosocial outcomes for young adults newly diagnosed with cancer. Analyses will also examine mechanisms of action and potentially identify subgroups for whom the intervention is particularly useful.

TRIAL REGISTRATION

clinicaltrials.gov #NCT04585269.

Addressing the Rising Trend in Early-Age-Onset Cancers in Canada

A multi-disciplinary symposium on early-age onset cancer (EAOC) was held in October 2023 to explore challenges experienced by this rapidly growing population. A major outcome of the symposium was recognition of the remarkable similarities of EAOC patients' journeys across cancer sites. Prevention and early detection of cancer are hindered by a lack of awareness among patients and family doctors that cancer can and does occur in younger persons. Distinct characteristics of the disease-such as a later stage at diagnosis and more aggressive tumor biology-require more potent treatments, which result in profound physical and psychosocial consequences that are unique to this age group. EAOC patient empowerment emerged as another key theme of the symposium. The development of a greater number of specialized clinics was called for, and patient support groups were recognized for the vital role they play in empowering patients and their families. Leading-edge medical advancements hold tremendous hope across the spectrum of EAOC care. New technologies based on genomic profiling, immunotherapy and microbiome alteration contribute to the development of highly effective, personalized approaches to treatment. All symposium participants expressed their commitment to speak with one resounding voice to advocate for equitable access to leading care practices for EAOC patients; thus, a fourth symposium is planned for November 2024.

Female cancer survivors: sexual function, psychological distress, and remaining fertility

PURPOSE

Improved survivorship in cancer patients leads to new challenging issues including potential impairment of quality of life, sexual function, and fertility. The aim of this study was to assess sexual dysfunction (SD) and psychological distress in female cancer survivors who underwent fertility preservation in the past in comparison to reviewed healthy control data from other published studies. Additionally, our focus was on the difference in SD between women with current desire to get pregnant and already completed family planning.

METHODS

In this prospective study, 53 female cancer survivors who underwent fertility preservation at time of cancer diagnosis between 2010 and 2020 were invited to a gynecological exam, laboratory assessment, and two questionnaires (Female Sexual Function Index (FSFI) and Hospital anxiety and depression scale (HADS)) in 2022. These scores were compared to results in the literature of healthy controls and depending on anti-Mullerian-hormone (AMH) levels, current desire to have a child, and age.

RESULTS

After a mean follow-up time of 70 ± 50 months, SD was detected in 60.4% (n = 32) of the 53 included patients. Normal results regarding HADS-D/anxiety and HADS-D/depression were found in 88.7% and 94.3% of patients, respectively. At time of follow-up, 69.9% (n = 40) regained regular menstrual cycles, 52.6% (n = 20) < 40 years showed a diminished ovarian reserve with AMH levels < 1.1 ng/ml and 28.3% (n = 15) suffered from infertility.

CONCLUSION

Female cancer survivors may be at risk for SD. Cancer patients should be informed about possible sexual dysfunction already at the start of cancer treatment and during follow-up. In addition, contraception needs to be addressed if regular cycles occur as more than two-thirds of the women regained regular menstrual cycles.