Psychosocial Care of Adolescent and Young Adult Patients With Cancer and Survivors Brad Zebrack and Sine ´ad Isaacson Brad Zebrack, University of Michigan School of Social Work, Ann Arbor, MI; and Sine ´ ad Isaacson, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Submitted September 14, 2011; accepted January 10, 2012; published online ahead of print at www.jco.org on March 12, 2012. Authors’ disclosures of potential con- flicts of interest and author contribu- tions are found at the end of this article. Corresponding author: Brad Zebrack, PhD, MSW, MPH, University of Michi- gan, 1080 S. University Room 2778, Ann Arbor, MI 48103; e-mail: zebrack@umich.edu. © 2012 by American Society of Clinical Oncology 0732-183X/12/3011-1221/$20.00 DOI: 10.1200/JCO.2011.39.5467 A B S T R A C T The delivery of quality care for adolescent and young adult (AYA) patients with cancer and survivors requires an understanding of the unique qualities of this group—the shared norms, attitudes, and beliefs that determine their behavior as well as the unique stresses they face on a day-to-day basis. All AYAs have typical concerns about being comfortable with who they are and who they want to become (identity development, including sexual identity), their bodies (body image), initiating intimate and emotional relationships, separating from parents, and making independent decisions about future goals such as career, higher education, and/or family (autonomy). Yet efforts of AYA patients with cancer and survivors to mature are often confounded by restrictions and limitations placed on them by their disease and treatment. This article promotes understanding of psychosocial challenges faced by AYAs when diagnosed with and treated for cancer. It reviews evidence-based psychosocial support interventions for AYAs with cancer and other life-threatening or chronic diseases, particularly the positive effects of peer support, technology-based interventions, and skill-based interventions. The article concludes with recom- mendations for clinical care that are intended to promote the ability of AYAs to cope with cancer. J Clin Oncol 30:1221-1226. © 2012 by American Society of Clinical Oncology INTRODUCTION Parent (confronting teenage child): “Why did you do that?” Teenage child (shrugs shoulders): “I dunno.” Parent: “What do you mean you don’t know?” Teenage child: “I don’t know.” Parents of teenage children, or physicians treat- ing adolescent and young adult (AYA) patients, may have conversations like this when confronting them about behaviors (eg, staying out too late, not adher- ing to prescribed treatment regimens) that the adults find ill considered or irresponsible. The re- sponses of the young person here typify the imma- ture cognitive capabilities that often drive the actions of AYAs. Although rightfully trying to treat AYAs as in- dependent and responsible decision makers, mature adults may sometimes have expectations of behavior that exceed the capabilities of AYAs. Goal-oriented behaviors, organization, planning, and impulse con- trol skills may not be realized before 25 years of age, when the frontal cortex of the brain typically be- comes fully developed. 1 Yet AYAs are capable of caring for themselves and making responsible choices. A relational approach that acknowledges their fledgling autonomy while positively reinforc- ing the importance of adhering to prescribed behav- iors keeps AYAs closer to adult supports than do punitive approaches that may result in distancing them from authority figures and role models. During the critical developmental transition from childhood to adulthood, AYAs have typical concerns about being comfortable with who they are and who they want to become (identity development, including sexual identity). They are acutely aware of their bodies (body image) and actively initiating intimate and emo- tional relationships, separating from parents, and mak- ing independent decisions about future goals such as career, higher education, and/or family (auton- omy). 2 When diagnosed with cancer, AYAs face ad- ditional challenges because of the intersection of the cancer experience with everyday aspects of their lives. Cancer-related issues such as premature con- frontation with mortality, changes in physical ap- pearance, increased dependence on parents, disruptions of social life and school/employment because of treatment, and loss of reproductive ca- pacity become particularly distressing. 3-6 AYA patients and survivors are challenged to remain active and independent, cope with treatment-related adverse effects, manage stress, seek and understand information, manage emo- tional responses (of self and others), seek social support, and accept cancer and maintain a posi- tive attitude. 7 However, AYAs with cancer rarely have the life experience necessary to know how or JOURNAL OF CLINICAL ONCOLOGY R E V I E W A R T I C L E VOLUME 30  NUMBER 11  APRIL 10 2012 © 2012 by American Society of Clinical Oncology 1221 Information downloaded from jco.ascopubs.org and provided by at UCLA on February 4, 2016 from 128.97.27.20 Copyright © 2012 American Society of Clinical Oncology. All rights reserved.