Elsevier

Seminars in Oncology

Volume 36, Issue 5, October 2009, Pages 468-477
Seminars in Oncology

Impact of malignant disease on young adults II
Psychosocial Outcomes and Service Use Among Young Adults With Cancer

https://doi.org/10.1053/j.seminoncol.2009.07.003Get rights and content

At the crossroads between pediatric and older adult groups, young adults with cancer may be underserved or inadequately or inappropriately served by existing support services. Empirical evidence has not established well the extent to which utilization of psychosocial support services delivered throughout a continuum of care results in desired outcomes. If self-efficacy is demonstrated to play a significant role in promoting quality of life and psychological well-being in young adult cancer patients, then a cancer-specific self-efficacy model can serve as an evidence-based framework for developing, implementing, and testing new interventions. A focus on self-efficacy has the potential to promote young adults' abilities to remain active and independent, seek and understand medical information, manage stress, cope with treatment-related side effects, maintain a “positive attitude,” regulate emotions, and seek social support. Future research should aim to identify which patients represent at-risk targets for intervention, as well as the most appropriate time points along the continuum of care at which patients/survivors are most likely to benefit from delivery/utilization of psychosocial support services.

Section snippets

Who is an “AYA”?

AYA cancer care falls into what has been described as a gap between pediatric and adult oncology.2, 5 The experience of cancer at any age represents a major stressor that may impact individuals' lives across multiple domains.6, 7 Cancer diagnosis and treatment may result in disruptions in daily activities, physical pain, diminished energy, changes to physical appearance, limitations in functional ability, altered social relations, confrontation with mortality and existential issues, and changes

Survival and Clinical Trial Participation

As reviewed in a previous article in this series, young adults with cancer have not benefited from advances in diagnosis, treatment, and survival to the extent that younger and older patients have.17 Lack of participation in, and/or availability of, clinical trials for the AYA age group may be a contributing factor to the lackluster improvements in mortality and survival for the AYA population, particularly given evidence that risks, risk factors, and responses to treatment may be different for

Psychosocial Effects of Cancer Among AYAs

Few empirical studies of cancer patients and survivors have distinguished the unique impacts, outcomes, and psychosocial service needs of AYAs. While a sizable body of literature exists for young adult survivors of cancer in childhood, the majority of psychosocial oncology research has involved homogenous samples of older adult patients or samples inclusive of patients across a wide range of ages. Haase and Phillips5 suggest that this gap in research is due to a common trend of clumping

The Unique Psychosocial and Health Care Needs of AYAs

Recent needs assessments of AYA cancer patients and survivors suggest that the high-priority biomedical healthcare needs for this population include the following: adequate health insurance coverage; a multidisciplinary approach to delivery of cancer care; treatment decisions that account for risks to the successful achievement of developmental tasks facing this population, such as education, family planning, career development and employment; and clinical trials and state-of-the art treatment

Psychosocial Service Use

In this review, we conceptualize psychosocial services in terms of Chesler and Barbarin's stress-coping model.99 This model is instructive in that it identifies domains—informational, practical, interpersonal, and emotional—upon which cancer patients and their family members experience (dis)-stress and seek support. Psychosocial support services may be conceived as a set of programs, activities, and resources that promote and enhance QOL for patients with cancer through education, research, and

Correlates and Outcomes of Service Use

In the absence of much empirical data on AYA cancer patients/survivors, literature on childhood cancer survivors and survivors of all ages again informs as to which variables may contribute to AYAs' use of psychosocial support services, as well as to the likelihood that they may benefit from doing so. In general, the literature is mixed and inconclusive. The most consistent differences in service use have been reported for gender, with female patients more likely to have used a range of

Self-Efficacy

Perceived self-efficacy refers to “beliefs in one's capabilities to organize and execute the courses of action required to produce given levels of attainments” (p. 3).4 In layman's terms, this refers to confidence that one can competently perform a given task, or perform within a given domain, such as managing the effects of cancer and its treatment. In Bandura's original theory,133 self-efficacy is conceived as contextually or domain-specific, as in the case of cancer or some other life

Conclusions

Despite the successes in medical treatment, the IOM report examining the psychosocial needs of cancer patients suggests that a full range of psychosocial services is not available to all patients diagnosed with and surviving cancer.3 Research efforts to identify and target at-risk subpopulations for culturally relevant and age-appropriate interventions are needed. Advances in knowledge will be derived from studies that are “patient-centered”144 in that they aim to identify potential mechanisms

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