Abstract
Simple SummaryAdolescents and young adult cancer survivors are vulnerable to psychological distress after completing cancer treatment. Telehealth (online videoconferencing) interventions may be able to address the gap in tailored, evidence-based supportive interventions. We evaluated an online, group-based, videoconference-delivered cognitive-behavioral therapy intervention (‘Recapture Life’) in a randomized trial. Forty cancer survivors between the ages of 15–25 years participated. No positive impacts on participants’ quality of life emerged immediately following the intervention, but Recapture Life participants reported using more adaptive coping skills. Recapture Life participants also reported higher negative impact of cancer, anxiety and depression at a 12-month follow-up. Additional analyses suggested that survivors benefitted differently from the two online interventions (Recapture Life vs. peer-support group) depending on how recently they had completed their cancer treatment. Our data highlight that different survivor sub-groups may find group-based, telehealth psychological interventions more or less helpful at different points in survivorship.Telehealth interventions offer a practical platform to support adolescent and young adult (AYA) cancer survivors’ mental health needs after treatment, yet efficacy data are lacking. We evaluated an online, group-based, videoconferencing-delivered cognitive-behavioral therapy (CBT) intervention (‘Recapture Life’) in a 3-arm randomized-controlled trial comparing Recapture Life with an online peer-support group, and a waitlist control, with the aim of testing its impact on quality of life, emotional distress and healthcare service use. Forty AYAs (Mage = 20.6 years) within 24-months of completing treatment participated, together with 18 support persons. No groupwise impacts were measured immediately after the six-week intervention. However, Recapture Life participants reported using more CBT skills at the six-week follow-up (OR = 5.58, 95% CI = 2.00–15.56, p = 0.001) than peer-support controls. Recapture Life participants reported higher perceived negative impact of cancer, anxiety and depression at 12-month follow-up, compared to peer-support controls. Post-hoc analyses suggested that AYAs who were further from completing cancer treatment responded better to Recapture Life than those who had completed treatment more recently. While online telehealth interventions hold promise, recruitment to this trial was challenging. As the psychological challenges of cancer survivorship are likely to evolve with time, different support models may prove more or less helpful for different sub-groups of AYA survivors at different times.
Highlights
Adolescent and young adult (AYA) cancer survivors experience high rates of common mental health difficulties, such as depression and anxiety disorders [1,2]
In the years since we developed Recapture Life, large-scale reviews have suggested that, while there may be some evidence to support the efficacy of selective-prevention interventions in reducing the severity of mental health disorders in the short term, longer-term data is more mixed, as is data on the efficacy of selectivepreventative interventions in preventing the onset of mental health disorders [9,10]
Advancing the field will require us to better understand the optimal strategies to use to achieve each goal. This trial demonstrated that AYAs engaged well with online, supportive interventions in the first two years following cancer treatment, though recruitment was a major challenge
Summary
Adolescent and young adult (AYA) cancer survivors experience high rates of common mental health difficulties, such as depression and anxiety disorders [1,2]. Considerable advances have been made in the development and implementation of age-appropriate, AYA-specific clinical and hospital-based services over the past decade [6,11,12,13,14,15]. These services typically focus on AYAs in active phases of cancer treatment. In addition to the practical benefits from reduced travel and its interruption to daily routines, community-based delivery of post-treatment support may reduce AYAs’ identity as a sick ‘patient’ and facilitate the transition towards a post-cancer identity as a capable, well-functioning adult [1,18]
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