Karen Fasciano, PSY.D., director of the Young Adult Program at Dana-Farber Cancer Institute, discusses the facts around young adults who are diagnosed with lymphoma, how the disease affects their life, and the resources available to young adults who are facing cancer. This presentation was originally given at the Lymphoma Research Foundation's 2013 North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
9873777170 Full Enjoy @24/7 Call Girls In North Avenue Delhi Ncr
How Young Adults Cope with Lymphoma
1. YOUNG ADULTS:
COPING WITH LYMPHOMA
Karen Fasciano, Psy.D.
Director of the Young Adult Program
Dana-Farber Cancer Institute
kfasciano@partners.org
18th Annual North American Educational Forum on Lymphoma
Lymphoma Research Foundation
September 27-29, 2013
Brooklyn, NY
3. YAs Diagnosed with Lymphoma
Lymphoma in YAs
(average per year 1999-2009)
Age
15-19
20-24
25-29
30-34
35-39
Total per year
Number
1023
1339
1502
1754
2220
7839
United States Cancer Statistics: 1999 - 2009 Incidence, WONDER Online Database. United States Department of"
"Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2011. Accessed at"
"http://wonder.cdc.gov/cancer-v2009.html on Sep 23, 2013 11:50:32 AM"
4. YA Survival Gap
Delayed diagnosis
Poor understanding
of the biology and
etiology
Inadequate access
to clinical trials and
low rates of
participation
Inadequate
treatment practices
and settings
Unique
psychosocial and
supportive care
Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER
needs.
Incidence and Survival: 1975-2000. National Cancer Institute, NIH Pub. No. 06-5767. Bethesda, MD 2006.
5. Improvements in Lymphoma
Not
all young adult cancers have had insignificant
increases in 5 year survival from 1975-1997
Over the past 10 years, Hodgkin’s (.35%) and
Non- Hodgkin’s lymphoma (3.35%) in 15-39 year
olds have had improvements in 5 year survival
rates.
(Bleyer, 2011 JAYA Oncology)
6. Young Adult Development
Cognitive
Emotional
Social
Early young
adult (18mid 20)
Critical thinking and
decision making
Future
consequences
Empathy
Language for
emotion
Mutual relationships
Appreciate differences
Modulation of risky
behaviors
Mentors sought
Financial responsibility
Spiritual questioning
Later young
adult (mid 20
+)
Advanced complex
thinking, decision
making
Brain development
ends
Self evaluation
Leadership
capacity
Commitment to work,
relationships, family
Evaluation of external
expectations
7. Contradicting Demands
Demands of Illness
Intimacy
Invulnerability
Independence
Control
Isolation
Vulnerability
Dependence
Uncertainty
Demands of Life Cycle
9. Emotional Distress
More emotional distress than other ages
Fatigue 5-13% higher than general population
Distress declines over time but greatest at
initial diagnosis and 12 months
Half of YAs indicated unmet need for mental
health counseling
Unmet need for mental health counseling
associated with worse quality of life
Moderate “ Post traumatic Stress Symptoms”
in 44%
Bellizzi et al, Cancer 2012 ; Kwak 2013 JCO , Zebrack 2012 Cancer; AYA Hope Study, Smith et al 2013; Daniels et al 2013 Ann Hemato
Kwak 2013 Psych-onc
10. Role of the Family
Family support and cohesiveness important to
adjustment
Higher family functioning associated with less
distress
Different family member perspectives contribute
to distress in family
Tension between independence and dependence
within the family
Levin et al (2000); Hill et al (1998); Grinyer (2009)
11. Impact of Cancer on YAs
Psychosocial impact
Positive
• Relationships
• Future goals/plans
• Health competence
Bellizzi et al, Cancer 2012
•
•
•
•
•
•
Negative
Financial
Body image
Control over life
Work plans
Relationship with partner
Plans for having children
12. Tools for YAs Coping with
Cancer
We need unique tools and
interventions for the young
adult population.
13. Peer Support
Support group services is a common unmet
need*
Interaction takes many forms
With advanced disease can also feel isolated
from “healthy” cancer peers
*AYA Hope Study, Smith et al 2013
14. Coping Skills: Managing Anxiety for YAs with Cancer
Session 1:
Introduction
CBT model of anxiety;
Intervention description
Session 2:
Self-Identity/Values
Define self-identity/values;
Application of personal values
Session 3:
Coping
Define coping; Identify personal coping style;
Develop coping plan
Session 4:
Communication
Describe communication styles;
Teach assertive communication
Session 5:
Behavioral Strategies
Deep breathing; Relaxation; Mindfulness;
Activity planning and pacing
Session 6:
Identifying thoughts
Define three types of thoughts;
Review cognitive errors
Session 7:
Examination
Describe automatic thoughts;
Examine thoughts; Cognitive restructuring
Session 8:
Problem-Solving
Identifying problems;
Problem-solving steps
Session 9:
Acceptance
Understand acceptance;
Acceptance strategies
Session 10: Review
Review; Relapse prevention
15. Advanced Care Planning:
Voicing My Choices
Adaptation of 5 wishes
20 AYAs with cancer or
HIV(15-28) provided
input
Revised document
92 AYAs gave input on
revised document
Content
My Signature
My Comfort
My Support
My Medical Care
Decisions
My Medical Treatment
My Family/Friends To
Know
My Spiritual Thoughts
My Remembrance
My Belongings
My Voice (Letters)
Glossary
Wiener et al 2008 Journal of Palliative Medicine; Wiener et al Pediatrics 2012, http://www.agingwithdignity.org/voicing-my
Although the presentation is on YA cancer- much of the literature has focused on the AYA gap.Surveillance, Epidemiology and End Results database
Brain development continues to mid twentiesLeadership capacity- shaping the rules
22 large studies that in- vestigated prevalence of fatigue or fatigue levels in HL survivors, showed prevalence rates of 11–76 % in HL sur- vivors, compared to 10 % in the general population. We also found 5–13 %, higher levels of fatigue in HL survivors when compared to the general population; differences that were mostly clinically relevant. There was some evidence that older age at diagnosis might lead to higher fatigue levels.
Face medical challenge and social and developmental transition
Post-traumatic stress symptoms include re-experiencing of the traumatic event, such as intrusive memories and nightmares; avoidance of thoughts, feelings, and reminders related to the trauma and emotional numbing; and persistent arousal, such as hyper-vigilance and insomnia The results showed that 44% of AYA patients reported at least moderate levels of PTSS approximately 1 year following their cancer diagnoses
First two in childhood cancer survivors,sthird in AYA
METHODS: This was a population-based, multicenter study of 523 newly diagnosed AYA survivors (ages 15-39 years) of germ cell cancer (n = 204), non-Hodgkin lymphoma (n = 131), Hodgkin lymphoma (n = 142), acute lymphocytic leukemia (n = 21), or sarcoma (n = 25) from 7 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registries. Age at diagnosis was categorized into 3 groups (ages 15-20 years, 21-29 years, and 30-39 years).RESULTS: Respondents (43% response rate), on average (±standard deviation), were aged 29 = 6.7 years, and most patients (80.1%) were not receiving treatment at the time the completed the survey. With modest differences between the age groups, the most prevalent areas of life impacted in a negative way were financial, body image, control over life, work plans, relationship with spouse/significant other, and plans for having children. Endorsement of positive life impact items also was evident across the 3 age groups, particularly with regard to relationships, future plans/goals, and health competence.CONCLUSIONS: The current results indicated that there will be future need for interventions targeting financial assistance, body image issues, relationships, and helping AYAs to attain their education objectives.Lymphomapatienta bout 20% of this cohort, not difference in disease
Us what we know and what we don’t know (AYA)Not legal but 5 wishes isThe wishes Document in Uk (family and medical team (Mw wishes younger, 5 wishes older.20 AYAs in focus group to determine document, would they find it helpful, answered 3 Q’s to participate in study (readiness questions)Asked to critically evaluate 5 wishes, most helpful least, what to add what to take outLots of thinks missing in 5 wishes (wiener 2008 )Jpm What was missing was developmental considerations (identity intimacy independence)Developed a new documentBorn or developed HIV at young ageNow reviewed VMC and 5 wishesQualitative data was most richWiener Pediatrics 2012Wish was not a good wordAll Chochivovs categories were important92 AYAs participated in this.