key: cord-0775246-9kanowl3
authors: Lichiello, Stephanie; Rainwater, Lisa; Russell, Gregory B.; Pulgar, Camila; Clark, Jaylyn; Daniel, Stephanie; McCall, Marcia H.; Bentley, Paige; Duckworth, Katie E.
title: Cancer during a pandemic: A psychosocial telehealth intervention for young adults
date: 2022-05-14
journal: Curr Probl Cancer
DOI: 10.1016/j.currproblcancer.2022.100865
sha: d6ec4797a5901f17caff5f51c9e2f538fa09c325
doc_id: 775246
cord_uid: 9kanowl3

The SARS-II COVID-19 pandemic has posed pronounced global health threats and prompted assorted transformations in societal engagement and clinical service delivery. For cancer survivors, many of whom are immune-compromised, these pandemic-related health threats pose greater challenges, warranting extra precautions within everyday living. Young adult (YA) cancer survivors already confront many unique physical and emotional challenges specific to their demographic. Already comfortable with assorted technologies, the pandemic presented an opportunity to provide virtual intervention that targeted social isolation and distress in an effort to facilitate healthy coping. Within this context, we created an 8-week virtual intervention for YAs (age 18-39) comprised of 60-minute sessions with interventions derived from Acceptance and Commitment Therapy and Meaning-Centered Psychotherapy. Participants reported a reduction in anxious preoccupation, helplessness/hopelessness, and psychological inflexibility and provided rich qualitative feedback on their experiences. Findings contribute new norms for an underinvestigated population navigating the dual health threats of cancer and COVID-19, provide practice recommendations with attention to the value of qualitative data capturing in group settings, and underscore participants’ preference for flexible group structure and age-related connections.

Cancer poses challenges to one's physical, emotional, and social well-being. Health anxiety, 2 depression, reduced social connectivity, and acute stress, often in the form of trauma, thread 3 across all diagnostic groups and can negatively impact quality of life. Young adult (YA) cancer 4 survivors (18-39) in active and post-treatment remain underrepresented in the oncology litera-5 ture. 1 One year postdiagnosis, approximately 25% of YA survivors report significant clinical dis-6 tress. 2 Body image concerns, unpleasant emotions, social isolation, and problems at school or 7 work are common 2 years after diagnosis. 3 Flexibility in care and age-appropriate psychoeduca- 8 tional materials have been found to increase autonomy and improve physical and psychological 9 outcomes in YAs through survivorship. 4 

The COVID-19 pandemic, with more than 79 million cases and over 964,0 0 0 deaths in the 11 United States as of March 2022, 5 exacerbated cancer survivors' existing distress and disrupted 12 oncology services. For YAs, the pandemic impacted many important developmental milestones 13 involving work, school, and socialization. Navigating cancer survivorship amid a pandemic fur-14 ther complicates coping processes and normal avenues of support. 15 Cancer survivors commonly contend with reduced immune functioning, placing many at 16 higher risk for viral contagion and/or comorbidities. Survivors presenting with COVID-19 face 17 a higher risk of being admitted to an ICU, being placed on a ventilator, or dying compared 18 to noncancer patients with COVID-19. 6 In addition to physical concerns, cancer survivors nav- 19 igating disease survivorship and dynamic pandemic conditions may be at even higher risk for 20 emotional distress and trauma as they confront dual health threats. Commonly reported mental 21 health concerns during a pandemic include anxiety, depression, and posttraumatic stress dis-22 order. 7 Consistent with these findings, many YAs endorse anxious and depressive symptoms, 23 hopelessness, and loneliness related to the COVID-19 pandemic. 8 The need exists for tailored 24 mental health interventions to help YA cancer survivors navigate the psychological impacts of 25 survivorship amid the ongoing pandemic. 26 As pandemic-era mental health visits usually take place online, equitable access to telehealth 27 opportunities is imperative. Cancer survivors, including YAs, rural or geographically distant, and 28 economically distressed individuals, may find this modality inviting due to familiarity or en-29 hanced access to care. 9-12 For YAs, acceptance of the modality were common even prior to 30 COVID-19. 13 Similar treatment outcomes exist for telehealth and in-person groups. 14 , 15 Success-31 ful outpatient telehealth services with YAs throughout the pandemic have been reported. 16 

We conducted a mixed methods pilot study of an 8-week telehealth support group for YA 33 cancer survivors that targets the constructs of health anxiety, depression, trauma, and social con-34 nectivity. Our aims were to: (1) replace avoidance coping skills with acceptance skills; (2) 

The 17-question investigator-created initial screening assessed group suitability with atten-69 tion to inclusion and exclusion criteria and was administered verbally during first phone con- The day before each scheduled session, an e-mail reminder was sent to all enrolled par- searching for themes, and refining themes (Reference Table 4 for themes and example quotes). 167 Participants found the Intervention helpful in offering support, facilitating connection, and learn-168 ing mindfulness skills. They also expressed their dislike of homework. Participants' emphasis and interest consistently focused on obtaining social support from oth-231 ers who had experienced similar challenges, rather than adherence to more structured material. 232 The different phases of survivorship within the group likely affected the dynamics of the conver-233 sation and relationship of the content discussed. We captured quantitative data with validated 234 instruments, but our approach was problematic for several reasons. First, achieving large sample 235 sizes in YA psychosocial oncology is difficult. 31 Second, COVID-19 precautions at the time of the 236 study reduced our already small clinical team from 6 to 4 clinicians, creating longer hours and 237 larger caseloads than prepandemic figures for the facilitators. Third, some of the most mean-238 ingful aspects of the group experience, such as intimate social connectivity, were absent from 239 quantitative data. In short, this study's attempt to co-construct a safe space to process, share, 240 and mutually learn new skills was not adequately captured by these outcome measures even 241 though we noted statistically significant movement in several constructs. desire loose structure and the ability to co-construct those experiences. It is our hope that these 249 practice recommendations will be useful for enhanced recruitment, and YAs will benefit from 250 such undertakings. 251

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