Roxanne Nelson, BSN, RN

October 25, 2017

A brief in-person intervention that only requires four counseling sessions appears to improve psychosocial health among adolescents and young adults living with cancer.

The intervention, called Promoting Resilience in Stress Management (PRISM), improved resilience and quality of life, increased hope, and lowered distress in the majority of patients.

"Adolescents and young adults with cancer have inferior psychosocial outcomes, including poor mental health and behaviors in survivorship," said lead study author Abby R. Rosenberg, MD, director of palliative care and resilience research at Seattle Children's Research Institute in Washington. "One reason may be that these patients have not yet developed the skills needed to navigate adversities such as cancer."

Dr Rosenberg presented the results of her study at a press briefing held in advance of the upcoming Palliative Care in Oncology Symposium (PCOS) 2017 in San Diego, California.

Psychosocial stress from cancer is common. It can be particularly difficult for adolescents and young adults. Because cancers in this age group are often aggressive and driven by genetics, patients may face many years of having to cope with consequences of cancer treatment. Their psychosocial needs are different because they are in a period of life transition.

Dr Rosenberg noted that although many programs provide some level of psychosocial support for patients and families, very few provide them with standardized tools to manage this stress. In this study, they evaluated a novel, brief, skills-based intervention that is designed to build four specific resilience resources in this population: stress management skills, goal-setting skills, positive reframing skills, and benefit-finding skills.

The study included 100 patients aged 12 to 25 years who had been diagnosed with new or newly recurrent cancer. The patients were randomly assigned to receive PRISM or usual psychosocial care. The patients were stratified into two groups by age: those aged 12 to 17 years, and those aged 18 to 25 years.

The PRISM intervention consisted of four one-on-one, in-person sessions of 30 to 60 minutes with a trained research associate. These sessions were followed by a facilitated family meeting. All participants completed patient-reported outcome surveys at the time of enrollment and 6 months later.

Of this group, 92 participants completed baseline responses (48 patients assigned to PRISM and 44 assigned to usual care). Of those who completed baseline responses, 73% were aged 13 to 17 years, and 27% were aged 18 to 25 years; 43% were female.

At 6 months, 74 participants were well enough to complete the follow-up survey (36 in the intervention group and 38 in the usual-care group). The PRISM cohort was associated with improvements in all instruments: resilience (+2.3; 95% confidence interval [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 0.0).

Importantly, Dr Rosenberg noted, the incidence of depression was much lower in the intervention group than in the usual-care group (6% vs 21%).

"This translated to significantly lower odds of developing depression," she said. "PRISM was associated with improved patient-reported resilience, improved cancer-specific qualify of life and hope scores, and fewer cases of depression.

"The psychosocial toll of cancer in a vulnerable population such as adolescents and young adults is often significant. This intervention represents an important beacon of hope for improving the lives of these patients," commented American Society of Clinical Oncology expert Andrew S. Epstein, MD, who moderated the briefing.

This study was funded in part by grants from the National Institutes of Health. The authors have disclosed no relevant financial relationships. Dr Epstein has a relationship with UptoDate.

Palliative Care in Oncology Symposium (PCOS) 2017. Abstract 176, to be presented October 28, 2017.

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