Journal of adolescent and young adult oncology最新文献

Purpose: Pediatric, adolescent, and young adult (PAYA) cancer survivors face complex long-term medical and psychosocial needs for which many health care professionals lack training. This study evaluated the PAYA Cancer Survivorship Extension for Community Health care Outcomes (ECHO) program, a virtual, case-based telementoring program, in improving health care professionals' self-reported knowledge and confidence in survivorship care.

Methods: A mixed-methods evaluation was done for the 12-session ECHO program (June 2024-May 2025). Surveys assessed changes in self-reported knowledge and confidence (5-point Likert scale), likelihood of applying learning, implementation barriers, and session impact. Quantitative data were analyzed using descriptive statistics.

Results: Participants included 219 health care professionals from 153 organizations across the 36 U.S. states, one federal district, and 5 countries. Average session attendance was 57 (M = 56.83, SD = 13.07). Self-reported knowledge increased from 2.8 to 3.5 with confidence increasing from 2.7 to 3.4; gains were statistically significant across all 11 content sessions (p < 0.05). Participants reported a high likelihood to apply session content (mean ratings 3.1-4.6 on a 5-point scale), with all sessions except Session 1 exceeding 4.2. The most frequently cited barriers to applying content were lack of resources (26%), lack of time (23%), need for more training (23%); 10% reported no opportunities to apply information, and 37% (n = 130) reported no barriers.

Conclusion: The ECHO program improved health care professionals' knowledge and confidence in PAYA survivorship care, with high intent to apply learning. Findings informed the launch of additional ECHO programs. Future efforts should further engage primary care providers and address barriers to translating knowledge into practice.

Purpose: Young adult (YA) cancer survivors aged 18-39 years face increased chronic disease risk. Although YA survivors prioritize health, structural barriers may limit their ability to maintain healthy lifestyles, particularly in culturally and geographically diverse regions. This mixed-methods study explored health priorities, social determinants of health (SDoH)-related barriers and facilitators to maintaining a healthy lifestyle, and intervention preferences for YA cancer survivors in New Mexico (NM) to inform future interventions.

Methods: Descriptive statistics and thematic analysis were conducted on surveys and semistructured interviews with 17 YA cancer survivors and 11 YA cancer care providers in NM. Surveys assessed demographics and, for survivors, SDoH, and intervention preferences.

Results: Social isolation was the most prevalent adverse SDoH, affecting 47% of YAs. YAs expressed interest in diet/physical activity-related programs (82%) and were flexible about group/one-on-one (59%) and in-person/online (71%) program formats. YA themes included: physical and mental health are priorities post-treatment; multilevel barriers and facilitators shape health behaviors; there is a lack of YA-specific resources; community building is key for peer support; support strategies to address psychosocial, behavioral, and health care navigation concerns are needed. Provider themes included: YAs have specific care needs during the survivorship transition to long-term wellness; collaborative, innovative organizational solutions are critical, peer and community support is effective, and integrating psychosocial and culturally informed care enhances outcomes; there is a need for empowering support tailored to the needs of YA survivors in NM.

Conclusion: Physical, mental, and social health are priorities for YA cancer survivors post-treatment. Findings highlight the need for flexible, community-informed interventions that support holistic health and long-term survivorship.

Purpose: High symptom burden and poor prognosis faced by adolescents and young adults (AYAs; aged 15-29) with advanced or recurrent cancer significantly impact their sense of identity and purpose as they work to achieve developmentally significant goals. The combination of high symptom burden and goal interference may exacerbate suffering, yet palliative care interventions have not addressed the co-occurring symptom management and existential concerns of this population.

Methods: Guided by the NIH Stage Model, we systematically developed a psychosocial symptom management intervention to address the needs of AYAs with advanced or recurrent cancer. Quantitative and qualitative data were obtained from AYAs (N = 20) and caregivers (N = 13) who completed semi-structured interviews and self-report measures to assist with intervention development of refinement. Rapid qualitative analysis was used.

Results: Intervention development interviews confirmed high symptom burden and the need to develop a psychosocial symptom management intervention targeting this population. A four-session intervention ("SMILE: Symptom Management for Improved PhysicaL and Emotional Wellbeing") was developed integrating behavioral symptom coping strategies with strategies from Meaning-Centered Psychotherapy and Acceptance and Commitment Therapy to (a) reduce symptom burden and interference and (b) promote engagement in values-driven, meaningful action in the face of life-limiting illness. Refinement sessions assisted with further clarifying concepts, tailoring the intervention to the population, and honing protocols.

Conclusions: SMILE is a novel integration of three evidence-based approaches to provide AYAs skills to address symptoms that interfere with valued and meaningful action. The feasibility and acceptability of SMILE will next be examined in a pilot randomized controlled trial.

Purpose: Childhood cancer survivors (CCS) face increased morbidity and mortality compared to the general population. Diet quality is an important modifiable factor influencing long-term outcomes. This study aimed to evaluate the diet quality of young adult CCS and compare it with age- and gender-matched peers.

Methods: Dietary intake from 25 young adult CCS was assessed using the Automated Self-Administered Dietary Assessment Tool (ASA24) and compared with 100 age- and gender-matched healthy control participants from the National Health and Nutrition Examination Survey 2017-2018. Differences in Healthy Eating Index (HEI) 2020 total and component scores were analyzed using independent t-tests.

Results: Overall, HEI scores did not differ between CCS and controls (p = 0.76). The CCS sample had a significantly higher intake of the following adequacy components: whole fruit (p = 0.03), total vegetables (p = 0.01), greens and beans (p = 0.01), total protein foods (p < 0.001), and dairy (p = 0.03). However, the CCS sample also reported a significantly lower unsaturated-to-saturated fatty acid ratio (p = 0.01) and a higher total fatty acid intake (p < 0.001).

Conclusions: Excessive consumption of saturated and total fatty acids may exacerbate long-term health risks; therefore, young adult CCSs may benefit from cancer-specific education and resources to encourage reducing unhealthy food consumption.

The number of adolescent and young adult cancer survivors (AYACSs) is increasing due to advancements in therapies. Despite these improvements, 70% of survivors experience long-term side effects. This systematic review aims to identify digital tools that enhance the quality of life and well-being of AYACSs aged 15-29 years. The review was conducted using four databases: PubMed, Science Direct, Cochrane, and PsycINFO (OVID platform). Articles from bibliographic references of selected studies were also included if relevant. The search followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and included studies published between January 2014 and December 2024 that described digital tools focusing on quality of life and/or well-being. Titles and abstracts were independently assessed by two reviewers, with a third reviewer resolving disagreements. The initial search identified 291 articles, updated in December 2024. After screening, 285 articles were excluded for not meeting the inclusion criteria. Three studies met the criteria, focusing on interventions related to information dissemination, physical activity, and psychological support. These studies, conducted in the United States and Australia between 2015 and 2024, included randomized controlled trials with measured outcomes related to quality of life and/or well-being. The findings suggest that digital tools can improve the quality of life of AYACSs, particularly through peer interaction and personalized content. However, the limited number of studies and participants highlights the need for further research. The review also discusses challenges in involving AYACSs in digital programs and suggests optimizing digital tools by promoting peer links, integrating social networks, and considering self-determination theory.

Purpose: Adolescent and young adult oncology patients represent a unique group with complex needs, yet data on palliative care utilization remain scarce in the Asian population. The definition of this group remains heterogeneous across organizations, and it is unclear whether extending the age range beyond conventional cutoffs affects observed patterns of care. We conducted a retrospective cohort study to describe palliative care utilization and end-of-life outcomes among oncology patients aged 16-45 years at a tertiary cancer center in Singapore.

Methods: Oncology patients aged 16-45 referred to the palliative team from 2011 to 2021 were identified using institutional databases. Chi-square tests and sensitivity analysis were used to compare outcomes across age groups. The timing of last treatment relative to palliative referral was described. Multivariable logistic regression was performed to identify predictors of aggressive care.

Results: Median age was 37 years; 58.8% were female; 83.6% of patients were deceased at the time of study. There was a trend toward earlier referrals in recent years, including during the COVID-19 pandemic. Outcomes including cause of death, place of death, rates of early/late referral, and aggressive care did not differ significantly across age groups. Timing of referral was the key independent factor associated with poor end-of-life outcomes including aggressive treatment.

Conclusion: Referral patterns and end-of-life care intensity are consistent across ages through 45 years. Late palliative referrals were associated with higher usage of aggressive treatment and death in hospital. Findings support integrated, timely access to palliative care in this group and validate flexibility in the definition of age ranges.

Purpose: The number of long-term childhood cancer survivors (CCSs) has been increasing, and the importance of transitioning from pediatric to adult care has been advocated. This study aimed to describe the health problems of adult CCSs from adult-care perspectives.

Methods: We conducted a chart review of adult CCSs aged ≥18 years who visited a transition clinic in adult care between June 2019 and March 2024.

Results: The study included 25 CCSs, with a median follow-up period of 14 months. The median number of medical departments requiring regular clinic visits was three (range 1-7). Among the participants, 15 (60%) had at least one severe health problem (grade 3 or higher). Notably, 45% (5 of 11) of participants with cardiovascular disease and 64% (9 of 14) of those with bone mineral density (BMD) deficiency were diagnosed after transition. During the follow-up period, 13 CCSs were hospitalized in the adult ward. Additionally, 52% (13 of 25) of the CCSs requested psychosocial intervention. Five CCSs who had health problems such as pituitary insufficiency, hearing loss, and visual impairment needed ongoing support from social workers.

Conclusion: Adult CCSs present with multiple health problems and risks. Because the health care system is different between adult care and pediatric care, comprehensive re-evaluation of health problems and care optimization from the adult-care perspective is important for the successful transition of CCSs to adult care.

Purpose: Adolescents and young adults (AYAs) with brain tumors are at an increased risk of developing psychiatric disorders. We aimed to investigate the incidence and characteristics of psychiatric disorders in AYA patients with brain tumors.

Methods: Using the Korean Classification of Diseases, we identified a cohort of AYA patients (aged 15-34 years) diagnosed with malignant brain neoplasms (C71) between 2003 and 2016 from the Korean National Health Insurance Claims Database. The analysis included 7052 patients.

Results: The 10-year cumulative incidence rate of psychiatric disorders was 21.5%. The most common psychiatric disorders were neurotic, stress-related, and somatoform disorders (11.4%), followed by mood (affective) disorders (9.4%). Factors associated with a higher incidence of psychiatric disorders included female sex (hazard ratio [HR] 1.16, 95% confidence interval [CI]: 1.05-1.28, p = 0.005), history of seizures (HR: 1.47, 95% CI: 1.31-1.66, p < 0.001), and brain tumor diagnosis during the latter part of the study period (HR: 1.14, 95% CI: 1.03-1.27, p = 0.010). Psychiatric hospital admissions were most frequent among patients with schizophrenia, schizotypal disorders, and delusional disorders (n = 5). The most common psychiatric disorders requiring psychotherapy were neurotic, stress-related, and somatoform (n = 580) and mood (n = 526) disorders.

Conclusion: A significant number of AYA patients with brain tumors develop psychiatric disorders after diagnosis, and most require treatment. Early detection through screening programs and personalized psychological support during and after cancer treatment may improve the mental health and quality of life of AYA patients with brain tumors.