Resilience intervention improves quality of life, lowers depression in young patients with cancer
Adolescents and young adults with cancer who participated in a one-on-one targeted intervention reported improvements in resilience, cancer-related quality of life and stress management, according to a study scheduled for presentation at the Palliative and Supportive Care in Oncology Symposium.
Patients in the program also had lower incidence of depression than those who had received usual psychosocial care, researchers reported.
“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,” Abby R. Rosenberg, MD, MS, director of palliative care and resilience research at Seattle Children’s Research Institute, said during a press conference. “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.”
Although many cancer programs provide some of level of psychosocial support for patients and families, few provide standardized tools to manage the stress associated with navigating the demands of the disease.
“Adolescents and young adults with cancer have inferior psychosocial outcomes, including poor mental health and health behaviors in survivorship,” Rosenberg said. “One reason for these disparities may be that this group of young people have not yet developed the skills needed to navigate adversities such as the cancer experience.”
Promoting Resilience in Stress Management, or PRISM, incorporates three sets of resources that can help manage adversity. These include internal resources, such as stress-management and mindfulness skills; community resources, such as social support; and existential resources, such as spirituality and the search for purpose.
The goal of PRISM is to cultivate internal 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,” Rosenberg said. “For example, we found that many young [patients with cancer] in our study identified things for which they were grateful, despite their cancer experience.”
Researchers randomly assigned 100 English-speaking patients aged 12 to 25 years diagnosed with new or recurrent cancer 1:1 to receive PRISM or usual psychosocial care.
The intervention included four one-on-one sessions lasting 30 minutes to 60 minutes delivered by a trained research associate, followed by a family meeting. All study participants received standard psychosocial supportive care, which included having 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 patient-reported outcome surveys at the time of enrollment and 6 months later.
Patient-reported resilience — measured using the Connor-Davidson Resilience Scale — served as the primary outcomes. Secondary outcomes measured changes at 6 months with the PedsQL 4.0 Quality-of-Life Inventory, the Snyder Hope Scale and the Kessler-6 Psychological Distress Scale.
Ninety-two patients (PRISM, n = 48; usual care, n = 44) completed baseline responses. Of those, 73% were aged 13 to 17 years, 27% were aged 18 to 25 years, and 57% were male.
Thirty-six patients in the PRISM arm and 38 in the usual care arm completed 6-month follow-up surveys; the decrease occurred primarily due to medical complications or death.
After adjusting for baseline scores, PRISM led to improvements in resilience (+2.3, 95% CI, 0.7-4.0), quality of life (+6.3; 95% CI, –0.8 to 13.5), hope (+2.8; 95% CI, 0.5-5.1) and distress (–1.6, 95% CI, –3.3 to 0).
Most notably, fewer patients in the intervention group than usual care group reported clinical depression (6% vs. 21%).
“We’ve determined that PRISM was associated with improved patient-recorded resilience and improved cancer-specific quality of life and hope scores, and fewer cases of depression,” Rosenberg said. “Brief developmentally targeted psychosocial interventions are feasible and promising for this population of adolescents and young adults with cancer.”
All but four of the PRISM participants chose to participate in the family meeting after their one-on-one interventions.
“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,” Rosenberg said. “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.”
Researchers noted future studies assessing larger cultural demographics and patients with advanced cancers are warranted.
“The psychosocial toll of cancer, especially in a vulnerable population like adolescents and young adults, is often significant,” said Andrew S. Epstein, MD, ASCO expert and medical oncologist at Memorial Sloan Kettering Cancer Center, who was not involved in the study. “The intervention by Rosenberg and her co-authors represents an important beacon of hope for improving the cancer experience for this population.” – by Chuck Gormley
Rosenberg AR, et al. Abstract 176. Scheduled for presentation at: Palliative and Supportive Care in Oncology Symposium; Oct. 27-28, 2017; San Diego.
Disclosures: An NIH grant helped fund this study. The authors report no relevant financial disclosures. Epstein reports a financial relationship with UpToDate.