Karen Fasciano

Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children.

Clinicians observe that advanced cancer patients with dependent children agonize over the impact their death will have on their children. The objective of this study was to determine empirically whether advanced cancer patients with and without dependent children differ in treatment preferences, mental health, and end‐of‐life (EOL) outcomes.

Identifying and Addressing the Needs of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine Workshop

Cancer is the leading disease-related cause of death in adolescents and young adults (AYAs). This population faces many short- and long-term health and psychosocial consequences of cancer diagnosis and treatment, but many programs for cancer treatment, survivorship care, and psychosocial support do not focus on the specific needs of AYA cancer patients. Recognizing this health care disparity, the National Cancer Policy Forum of the Institute of Medicine convened a public workshop to examine the needs of AYA patients with cancer. Workshop participants identified many gaps and challenges in the care of AYA cancer patients and discussed potential strategies to address these needs. Suggestions included ways to improve access to care for AYAs, to deliver cancer care that better meets the medical and psychosocial needs of AYAs, to develop educational programs for providers who care for AYA cancer survivors, and to enhance the evidence base for AYAs with cancer by facilitating participation in research.

Patient-Oncologist Alliance, Psychosocial Well-Being, and Treatment Adherence Among Young Adults With Advanced Cancer

PURPOSE Patients who develop a strong alliance with their health care providers have been shown to have higher levels of psychosocial well-being and rates of treatment adherence. Young adults with cancer have lower levels of psychosocial well-being and treatment adherence relative to patients with cancer in other age groups. This study sought to evaluate the relationships between the patient-oncologist alliance, psychosocial well-being, and treatment adherence in young adults with advanced cancer. PATIENTS AND METHODS Ninety-five young adults (age 20 to 40 years) with advanced cancer were administered measures of alliance, psychosocial well-being, willingness to adhere to treatment, and treatment adherence. Relationships between alliance and psychosocial well-being were examined bivariately. Multiple linear regression models examined the relationship between alliance and adherence, controlling for confounding influences (eg, psychosocial well-being). RESULTS Alliance was significantly (P ≤ .01) and positively associated with greater perceived social support and less severe illness-related grief. After controlling for significant confounding influences (ie, metastases, appraised support, and grief), alliance remained significantly (P ≤ .01) associated with greater willingness to adhere to treatment and greater adherence to oral medication. CONCLUSION By developing a strong alliance, oncologists may enhance psychosocial well-being and increase treatment adherence in young adult patients with advanced cancer.

Coping and psychological distress in young adults with advanced cancer.

BACKGROUND Little is known about how young adults (YAs) cope with cancer or about the relationship between coping and psychological distress in YAs with advanced cancer. OBJECTIVES The goals of this study were to identify coping strategies used by YAs with advanced cancer and examine the relationship between these coping strategies and psychological distress. METHODS Using structured clinical interviews with 53 YAs (aged 20-40 years) with advanced cancer, researchers assessed coping methods, depression, anxiety, and grief. A principal components factor analysis identified underlying coping factors. Regression analyses examined the relationship between these coping factors and depression, anxiety, and grief. RESULTS Six coping factors emerged and were labeled as proactive, distancing, negative expression, support-seeking, respite-seeking, and acceptance coping. Acceptance and support-seeking coping styles were used most frequently. Coping by negative expression was positively associated with severity of grief after researchers controlled for depression, anxiety, and confounding variables. Support-seeking coping was positively associated with anxiety after researchers controlled for depression and grief. LIMITATIONS This study was limited by a cross-sectional design, small sample size, and focus on YAs with advanced cancer. CONCLUSIONS YAs with advanced cancer utilize a range of coping responses that are uniquely related to psychological distress.

Young Adult Palliative Care: Challenges and Opportunities

Young adulthood is a time of immense growth and possibilities. As a result, it is also a time when serious illness can have profound effects. This review examines the current data pertinent to young adult palliative care and discusses the challenges and opportunities where palliative medicine can enhance the care provided to this growing and vulnerable population. From the data, 2 primary themes emerged (1) ongoing young adult development not only generates unique biologic disease burdens and clinical treatment options but also requires frequent assessment and promotion and (2) binary health care systems often leave young adults without access to developmentally appropriate health care. Given its interdisciplinary approach, palliative care is uniquely poised to address the challenges known to caring for the seriously ill young adult.

Cancer treatment decision-making among young adults with lung and colorectal cancer: a comparison with adults in middle age

Our aim is to understand experiences with treatment decision‐making among young adults with cancer.

Communication About Prognosis With Adolescent and Young Adult Patients With Cancer: Information Needs, Prognostic Awareness, and Outcomes of Disclosure

Purpose Communication about prognosis affects decisions patients and family members make about cancer care, and most patients say they want to know about their chances of cure. We sought to evaluate experiences with prognosis communication among adolescents and young adults (AYAs) with cancer. Patients and Methods We surveyed 203 AYAs with cancer age 15 to 29 years (response rate, 74%) treated at Dana-Farber Cancer Institute and their oncologists. Patients were approached within 6 weeks of diagnosis and asked to report on their prognosis communication preferences and experiences, their beliefs about likelihood of cure, and psychosocial outcomes of communication, such as trust (using an item from the Trust in Physician Scale), peace of mind (using select items from the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale), and anxiety and depression (using the Hospital Anxiety and Depression Scale). Oncologists were asked to report the patients likelihood of cure. Results Most patients (83%, 167 of 203 patients) considered prognostic information to be extremely or very important. Patients who reported having received more extensive prognostic disclosure had higher odds of trust in the oncologist (odds ratio [OR], 1.30; 95% CI, 1.01 to 1.67; P = .05), peace of mind (OR, 2.13; 95% CI, 1.29 to 3.51; P = .002), and hope related to physician communication (OR, 1.27; 95% CI, 1.01 to 1.59; P = .04), after adjusting for patient sex, age, race or ethnicity, prognosis, and diagnosis. Disclosure was also associated with lower distress related to knowing about prognosis (OR, 0.65; 95% CI, 0.44 to 0.95; P = .03). However, a majority of patients (62%) reported prognostic estimates that exceeded those reported by physicians (McNemar P < .001). Conclusion Most AYAs with cancer value receiving prognostic information, which is positively associated with aspects of well-being. However, most overestimate chances of cure relative to oncologists, highlighting the importance of efforts to improve communication with this young population.

Understanding the psychosocial needs of young adults with cancer: Identifying targets for clinical intervention.

9068 Background: The NCI has recognized the unique burden of cancer for young adults (YAs) and called for specialized services to address their needs. Few studies have investigated the nature of distress in YAs, making development of targeted psychosocial interventions difficult. The present study advances understanding of YA psychosocial needs by examining correlates of quality of life, suicidal ideation, and disruption of work, social, and family life in patients with advanced cancer. METHODS Structured clinical interviews were conducted between April 2010 and January 2011 with 40 YA advanced cancer patients (age range 20-40 yrs, M=35.2, SD=5.16) receiving care at Dana-Farber Cancer Institute. Validated measures assessed quality of life (e.g. Global McGill Quality of Life Questionnaire), psychopathology, grief over cancer-related losses, coping methods, and psychosocial variables of clinical interest. Quality of life scores were regressed individually on grief, psychopathology, illness acceptance, patient-oncologist therapeutic alliance, social support, and coping methods. Significant bivariate associations were entered into multivariate models to identify the most significant set of influences. The same set of independent variables was used in models of life disruption and suicidal ideation. RESULTS In bivariate analysis, grief, illness acceptance, therapeutic alliance, social support, depression, and coping methods were associated with quality of life (p<.05). In multivariate analysis, less grief (B=-.54, SE=.43, df=29, p<.01) and more social support (B=.32, SE=.62, df=29, p<.05) remained significant predictors of better quality of life. In multivariate analysis, more grief predicted more suicidal ideation (B=.54, SE=.036, df=29, p<.01) and less illness acceptance predicted more life disruption (B=.51, SE=.31, df=29, p<.01). CONCLUSIONS For YAs with advanced cancer, grief, social support, and illness acceptance are critical to quality of life, functionality, and will to live. Clinical interventions that reduce grief, promote illness acceptance, and enhance social support may address the unique psychosocial needs of YA cancer patients.