2017 ASCO Palliative Care: Resilience Intervention Improves Quality of Life for Adolescents and Young Adults With Cancer
Although a cancer diagnosis is daunting at any age, adolescents and young adults (AYAs) with the disease often face unique challenges and are at risk for poor psychosocial outcomes than older patients. A randomized study investigating whether a brief, age-appropriate, skills-based intervention called Promoting Resilience in Stress Management (PRISM) in AYAs with cancer could improve their psychosocial health and quality of life has found that the intervention improved resilience and cancer-related quality of life, increased hope, and lowered distress compared with patients receiving usual psychosocial care only. In addition, the incidence of depression was much lower in the intervention group compared with the usual care group. The study is being presented by Rosenberg et al at the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego (Abstract 176).
Study Methodology
The researchers recruited 100 English-speaking AYA patients aged 12 to 25 years who were diagnosed with new or newly recurrent cancer. The patients were stratified into two groups, those aged 12 to 17 and those aged 18 to 25.
Patients were randomized to receive either PRISM, a manualized, brief intervention targeting stress management, goal-setting, cognitive reframing, and meaning-making, or nondirective usual psychosocial care. PRISM consists of four 30- to 60-minute in-person, one-on-one sessions with a trained research associate plus a facilitated family meeting.
Study participants completed patient-reported outcome surveys at the time of enrollment and 6 months later. The researchers used mixed-effects regression modeling to estimate associations between PRISM and the primary outcome (patient-reported resilience, measured by the Connor-Davidson Resilience Scale [CDRISC-10]) and secondary outcomes (health-related quality of life [PedsQL 4.0 Quality of Life Inventory], hope [Snyder Hope Scale], and psychological distress [Kessler-6 Psychological Distress Scale]) at 6 months.
Regardless of which group they were in, all participants received standard psychosocial supportive care, including a dedicated social worker and access to psychologists, child-life specialists, and other experts in AYA oncology care.
Study Results
The study enrolled 100 AYAs (78% of those approached) and assigned 50 to the PRISM intervention and 50 to usual care; 92 completed baseline surveys (48 PRISM, 44 usual care). Among this group, 73% were aged 13 to 17 years and 27% were aged 18 to 25 years, and 43% were female.
Attrition was similar in each arm and primarily due to medical complications or death; 36 (72%) in the PRISM group and 38 (76%) in the usual care group completed 6-month patient-reported outcome surveys. After adjusting for baseline scores, PRISM was associated with improvements in all instruments: Resilience (+2.3, 95% confidence interval [CI] = 0.7 to 4.0), quality of life (+6.3, 95% CI = –0.8 to 13.5), hope (+2.8, 95% CI = 0.5 to 5.1), and distress (–1.6, 95% CI = –3.3 to 0.0).
“We determined that PRISM was associated with increased patient-reported resilience and increased cancer-specific quality of life in hope scores and fewer cases of depression,” said lead of author Abby R. Rosenberg, MD, Director of Palliative Care and Resilience Research at Seattle Children’s Research Institute, at a press conference announcing the study’s results. “Developmental-targeted psychosocial interventions are feasible and promising for this population of AYAs with cancer.”
The study authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
