Online Interventions to Improve Mental Health of Pediatric, Adolescent, and Young Adult Cancer Survivors: A Systematic Review and Meta-Analysis

Objective: Over the last 10 years, online interventions to improve mental health have increased significantly. This study's primary objective was to determine the effectiveness of online interventions in improving the mental health of pediatric, adolescent, and young adult (PAYA) cancer survivors. The secondary objective was to identify the independent variables associated with online intervention efficacy for mental health improvement.Methods: On June 25–30, 2021, we searched the Medline, PsycINFO, EMBASE, and Cochrane databases for eligible English language publications that reported randomized controlled trials of online interventions aimed at improving mental health among PAYA cancer survivors. The results were analyzed using a systematic review and a three-level meta-analysis.Results: Thirteen studies met the inclusion criteria. In six (42%) studies, the intervention focused on physical activity enhancement, while ten (77%) studies used self-directed interventions. Online interventions were more efficacious, compared to control conditions, in improving sleep g = 0.35 (95% CI 0.04–0.66) and psychological well-being g = 0.32 (95% CI 0.09–0.56), but not for reducing the symptoms of depression g = 0.17 (95% CI −0.13 to 0.47), anxiety g = 0.05 (95% CI −0.15 to 0.25), and pain g = 0.13 (95% CI −0.13 to 0.39).Conclusion: Online interventions were generally effective in improving mental health in PAYA cancer survivors, although negative results were found in some critical outcomes. More high-quality evidence is needed for definite conclusions to be drawn. The study protocol was registered in PROSPERO (CRD42021266276).

Development of a questionnaire to understand the information needs of adolescent and young adult cancer survivors for life and long-term health following cancer treatment.

Disease outcomes for adolescents and young adults (AYA: ages 15 – 39 years old) with cancer have improved significantly over the past four decades to over 80%. AYA survivors are a unique population who have decades of life years following cancer treatment and are at very high risk for developing chronic medical and mental health conditions. Unfortunately, there is gap by providers in providing information regarding expectations of long-term medical, cognitive, and psychosocial issues that may arise during their lifetime. The goal of this project was to understand the educational/informational needs of this unique population. In order to understand the type of information AYAs would like to know post-treatment, such as exercise, nutrition, and more, we developed a survey addressing key topics. The process of collecting data has begun and will be collected for an additional five months. Subsequently, data will be analyzed by our team to determine key areas of interest. We will then utilize social media platforms to target AYA survivors and disseminate educational information addressing those areas of interest. The overarching hypothesize is that minimizing the health information gap and increasing knowledge about survivorship in the AYA cancer population via an accepted social media platform will lead to a more informed population of survivors that can better address their life long healthcare.

Developing a Survey for Analyzing Attitudes of Adolescent and Young Adult Cancer Survivors Towards Diet, Exercise, and Social Media

Background and Hypothesis: Due to improved multidrug treatments over the past 40 years, the 5-year survival rate for children diagnosed with cancer has increased from approximately 60% to 85%. However, these treatments also cause long-term health issues, so patients must be equipped with adequate information regarding potential future complications. Only 18% of survivors report follow-up visits to a physician to discuss reducing risks resulting from their cancer, thus, there is a huge gap in health education for this population. To address this gap, a questionnaire was developed to collect data on the critical concerns adolescent and young adult (AYA) survivors have regarding wellness. We hypothesize that this survey will allow for healthcare workers to have a greater understanding of the wellness needs of AYA cancer survivors and aid in the development of an educational program that can be delivered in a manner that is acceptable to the AYA survivor population. Project Methods: A 5-point Likert scale survey was created to gather information on topics such as diet, exercise, body image, relationships, and social media. Additional questions that gather data on background information were also asked. This survey will be distributed to subjects who have recovered from cancer and are between the ages of 18 and 39. After data has been collected, statistical tests such as Spearman’s correlation and chi-square tests for independence will be used to find correlations. Expected Results: Results from this survey will be useful in understanding the experiences of AYA cancer survivors, how they view their wellness needs, and how they prefer to receive healthcare information. Potential Impact: The data from this study will inform oncology providers as to which health concerns the AYA survivor population find most important and how best to deliver that information so survivors can receive better management of their long-term health.

Bounce Back Study Protocol: Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors (Preprint)

BACKGROUND The emotional health of adolescent and young adult cancer survivors (AYAs) is compromised both during and after cancer treatment. Targeted programs designed to support AYAs’ ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship. OBJECTIVE Our randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among post-treatment AYAs. METHODS Bounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (SMART-3RP) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14-29 and had completed cancer treatment within the last five years) were randomly assigned to the Bounce Back program or waitlist control group and completed assessments at baseline, three months, and six months post-baseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (i.e., anxiety, depression) collected across the three timepoints. RESULTS This study was funded by the National Cancer Institute in July, 2017. Study procedures were approved by the Dana Farber Harvard Cancer Center IRB in October, 2018 (Protocol 18-428). The randomized trial was conducted from July 2019- March of 2021. Quantitative data collection is complete and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, and/or international meetings in the coming years. CONCLUSIONS Few evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being. CLINICALTRIAL Clinicaltrials.gov NCT03768336