“Cancer is a daunting disease regardless of a person’s age. Adolescents and young adults with cancer face an especially unique and challenging experience as they deal with the physical and emotional difficulties of cancer treatment at the same time they are coping with the normal stresses of adolescence and entering adulthood,” said ASCO Expert Andrew S. Epstein, MD, moderator of today’s presscast.
ALEXANDRIA, Va. – A new randomized clinical trial of a pilot program found that a brief in-person intervention can improve psychosocial health in a particularly vulnerable population – adolescents and young adults living with cancer.
Psychosocial stress from cancer is common and is often a major detriment to quality of life. For example, one type of stress is anxiety over how to navigate the demands of the disease. Although many programs provide some level of psychosocial support for patients and families, very few provide standardized tools to manage this stress.
The intervention, called Promoting Resilience in Stress Management, or PRISM, improved resilience and quality of life, increased hope, and lowered distress in the majority of patients. These findings will be presented at the upcoming 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, California.
“The experience of cancer is stressful in all realms, but we tend to focus more on physical symptoms than the equally important social and emotional challenges,” said lead study author Abby R. Rosenberg, MD, Director of Palliative Care and Resilience Research at Seattle Children’s Research Institute. “This is particularly true for adolescents and young adults who already struggle with normal developmental changes. When you throw cancer into the mix, it can become much harder.”
PRISM emerged from a theory of resilience that puts forth three sets of resources that can help manage adversity: internal resources, such as stress-management or mindfulness skills; community resources, such as social support; and existential resources, such as spirituality and the search for purpose. In prior research, the investigators found that internal and existential resources were more teachable than tapping community resources. PRISM was tested in an earlier feasibility study with young patients with either diabetes or cancer.
About the Study
In this clinical trial, 100 English-speaking patients ages 12 to 25 years who were diagnosed with new or newly recurrent cancer were randomly assigned to receive PRISM or usual psychosocial care. The intervention was delivered in four 30-minute to hour-long one-on-one sessions with a trained research associate, followed by a family meeting. PRISM cultivated internal resilience resources that strengthen stress management and goal-setting, as well as existential resilience resources that strengthen cognitive reframing and meaning-making.
“Meaning-making is basically deriving some personal perspective or purpose from adversity,” said Dr. Rosenberg. “For example, we found that many young cancer patients in our study identified things for which they were grateful, despite their cancer experience.”
Regardless of which group they were in, all participants received standard psychosocial supportive care, including a dedicated social worker and access to psychologists, child-life specialists, and other experts in adolescent and young adult oncology care, as needed.
Patients completed surveys at enrollment and six months later. The authors found that the intervention improved psychosocial well-being.
Specifically, among the 74 participants who remained alive and well enough to complete the 6-month survey (36 in the intervention group and 38 in the usual care group), those who received the intervention had improvements in resilience, cancer-related quality of life, hope, and distress compared with those who received usual psychosocial care. In addition, the incidence of depression was much lower in the intervention group compared with the usual care group (6% vs. 21%).
All but four of the PRISM recipients chose to participate in the family meeting following their one-on-one skills-training sessions. “We included the family meeting because teens told us they wanted to share with their parents, and parents told us they wanted to know what their children had learned,” said Dr. Rosenberg. “While the specific impact of this meeting is yet to be determined, we hope it will guide families so that there is continued support of teen or young adult patients.”
“We need to include a much larger cultural demographic in future studies,” said Dr. Rosenberg. “Beyond that, we also need to determine if this type of intervention could translate to other centers where usual care may not be as comprehensive as what we have here.”
The investigators would also like to test PRISM in patients with advanced cancers and possibly expand to other diseases, such as cystic fibrosis.
This study was funded in part by a grant from the National Institutes of Health.
View the full abstract.
For your readers:
2017 Palliative and Supportive Care in Oncology Symposium News Planning Team:
Joseph Rotella, MD, MBA, HMDC, FAAHPM, American Academy of Hospice and Palliative Medicine (AAHPM); Andrew S. Epstein, MD, American Society of Clinical Oncology (ASCO); and David Warr, MD, FRCP, Multinational Association of Supportive Care in Cancer (MASCC).
Click here to view the disclosures for the News Planning Team.
ATTRIBUTION TO THE 2017 PALLIATIVE AND SUPPORTIVE CARE IN ONCOLOGY SYMPOSIUM IS REQUESTED IN ALL NEWS COVERAGE.
About the American Academy of Hospice and Palliative Medicine:
The American Academy of Hospice and Palliative Medicine AAHPM) is the only national medical specialty society for hospice and palliative medicine. Since 1988, AAHPM has supported hospice and palliative medicine through professional education and training, development of a specialist workforce, support for clinical practice standards, research, and public policy advocacy. AAHPM’s membership includes 5,000 physicians and other healthcare professionals committed to improving the care of patients with serious illness. Learn more at www.aahpm.org or visit our patient website, www.PalliativeDoctors.org. Follow us on Twitter, Facebook, LinkedIn and YouTube.
Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to making a world of difference in cancer care. As the world’s leading organization of its kind, ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of the highest-quality patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, and YouTube.
About the American Society for Radiation Oncology:
The American Society for Radiation Oncology (ASTRO) is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologist, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology, Biology, Physics, Practical Radiation Oncology, and Advances in Radiation Oncology, developed and maintains an extensive patient website; and created the Radiation Oncology Institute, a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment.
About the Multinational Association of Supportive Care in Cancer:
The Multinational Association of Supportive Care in Cancer (MASCC) is an international, multidisciplinary organization with members from six continents and nearly 70 countries. It operates in collaboration with the International Society of Oral Oncology (ISOO). Founded in 1990, MASCC is dedicated to research and education in all areas of supportive care for patients with cancer, regardless of the stage of the disease. MASCC promotes professional expertise in supportive care through research and the scientific exchange of ideas. A focus on supportive care leads to better treatment outcomes and greater quality of life for people with cancer.