Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress

Josefin Hagström; Malin Ander; Martin Cernvall; Brjánn Ljótsson; Henrik W Wiman; Louise von Essen; Joanne Woodford

doi:10.7717/peerj.8714

Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress

PeerJ. 2020 Mar 19:8:e8714. doi: 10.7717/peerj.8714. eCollection 2020.

Authors

Josefin Hagström¹, Malin Ander¹, Martin Cernvall¹, Brjánn Ljótsson², Henrik W Wiman¹, Louise von Essen¹, Joanne Woodford¹

Affiliations

¹ Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden.
² Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.

Abstract

Background: A subgroup of adolescent and young adult (AYA) survivors of cancer during adolescence report high levels of psychological distress. To date, evidence-based psychological interventions tailored to the cancer-related concerns experienced by this population are lacking. The present study aimed to (1) examine the feasibility and preliminary efficacy of an individualized cognitive behavioral therapy (CBT) intervention for AYA survivors of cancer during adolescence; and (2) identify and conceptualize cancer-related concerns as well as maintaining factors using cognitive-behavioral theory.

Methods: A single-arm trial, whereby AYA survivors of cancer during adolescence (aged 17-25 years) were provided individualized face-to-face CBT at a maximum of 15 sessions. Clinical outcomes were assessed at baseline, post-intervention, and three-month follow-up. Intervention uptake, retention, intervention delivery, and reliable change index scores were examined. An embedded qualitative study consisted of two unstructured interviews with each participant pre-intervention. Along with individual behavioral case formulations developed to guide the intervention, interview data was analyzed to identify and conceptualize cancer-related concerns and potential maintaining factors.

Results: Ten out of 213 potential participants invited into the study were included, resulting in an overall participation rate of 4.7%. Nine participants completed the intervention, with respectively seven and eight participants completing the post-intervention and three month follow-up assessment. The majority of reported cancer-related concerns and maintaining factors were conceptualized into four themes: social avoidance, fear of emotions and bodily symptoms, imbalance in activity, and worry and rumination.

Conclusions: Given significant recruitment difficulties, further research is required to examine barriers to help-seeking in the AYA cancer survivor population. However, the conceptualization of cancer-related concerns and maintaining factors experienced by the population may represent an important first step in the development of psychological support tailored toward AYA cancer survivors' unique needs.

Keywords: AYA survivor; Behavioral conceptualization; CBT; Cancer; Feasibility; Internet-based intervention; Psychological concerns.

Grants and funding

This work was supported by the Swedish Childhood Cancer Foundation, grant numbers PR2013-0039; PR2016-0004 and PR2017-0005, the Swedish Cancer Society, grant number 13 0457, and funding via the Swedish Research Council to the strategic research program U-CARE. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.