People diagnosed with cancer between the ages of 15 and 39 are commonly referred to as the adolescent and young adults (AYA) population. To date, this group is sometimes misunderstood and often underserved. Sage Bolte (2015) states, “Young adults with cancer experience higher risks of mental health symptoms, including anxiety, depression, PTSD, and suicidal thinking, than do older cancer patients." (p. 52) In addition, AYAs with cancer face issues and concerns that differ from those of children or older adults with cancer (Katz, 2015).

Concerns for this group include isolation, coping, relationships, developmental milestones, sexual identity, normalcy, cancer education, insurance and financial issues, and survivorship (Bolte, 2015; Masterson & Tariman, 2016). The need to assess and address these topics with our AYA patients is ever growing. Bolte says “Issues of survivorship and other biopsychosocial-spiritual factors in this population present an opportunity for oncology social workers to make a difference” (pg. 507). We social workers can use our unique training and experience to help this population transition through diagnosis, treatment and survivorship.

Social workers, as integral members of the medical team, can maximize this opportunity by becoming involved with AYA patients early on in their cancer journey. Once we are consulted to assess an AYA patient, how do we know where to start? What type of therapy is the best approach? Fortunately, there are several styles of therapy that have been found to be effective for adolescents and young adults with cancer. Masterson and Tariman (2016) conducted a literature review of four types of therapy used when working with AYA patients transitioning into survivorship: dynamic group therapy, online cognitive-behavioral therapy, online cancer forum and an educational cancer retreat. They found that while some AYAs in each group benefited from the therapy, not all in each group reported having benefitted. Not one type of therapy worked for all AYA patients. The literature suggests interventions should be tailored to address the needs identified by the AYA patient and should be presented in a way congruent with his or her developmental stage (Masterson & Tariman, 2016). Social workers can address the changing needs of AYA patients through the course of diagnosis, treatment and beyond. The sooner a social worker is engaged with an AYA patient, the better.

Bolte (2015) provides additional strategies for working with AYAs:

• Provide information and education. Start where the patient is. What do they already know and understand? What more do they want to know? They may want information on diagnosis, treatment, insurance coverage, employment and fertility or they may not want  further information. We need to advocate for them to receive information when they are ready.
   
• Be creative in delivering services and therapy. We should know our patients as individuals rather than just patients. What are their hobbies? Who is important to them? Social workers should work with AYA patients to identify their strengths and interests and build on them.
   
• Start a group and involve AYAs as group “champions.” One of the first concerns identified for AYAs is feeling alone. In-person or online support groups can provide ways for them to connect with others in similar situations. When an AYA is a group leader or champion, they have an opportunity for ownership of the group and the process. Support from peers can mean more to an AYA than support from staff.
   
• Normalize their feelings. Social workers should help patients understand that they are not the only ones feeling what they are feeling. Their feelings can sometimes change from moment to moment and they need to know they are not alone.
   
• Continually assess psychosocial well-being. Patients with cancer have needs that change over time and require assessment and evaluation especially at pivotal times of treatment. Check in with your patient from time to time to reassess their needs and goals.
   
• Create a treatment plan to address their goals and concerns. Patients should be active participants in identifying what is important to them and how to go about improving their lives. Social workers guide patients with consideration to maintain patient ownership in the process and work towards goals.
   
• Know the resources. Oncology social workers need to be up to date on what is available in the community. Patients may benefit from something our institution cannot offer and community resources may be able to bridge any gaps.

The importance of meeting the unique needs of the AYA population is gaining attention in oncology care. Websites such as stupidcancer.org provide resources, information and connections for this group. CancerCare recently started offering online support groups specifically for AYAs and their loved ones. AOSW featured AYAs with cancer as a topic at recent conference and the NCCN has a guideline for working with adolescents and young adults with cancer. The AYA movement continues to gain momentum and social workers can be at the forefront of this work.

Oncology social workers have an opportunity to identify and address the psychosocial needs of adolescent and young adult patients. When we create a trusting relationship with these patients and get to know them as individuals, we can find creative ways of offering psychosocial support. Understanding and combining tactics from different models of therapy gives social workers a variety of tools to provide a therapeutic approach tailored to each AYA patient.

References

Bolte, S. (2015). Young adults (20 to 39) with cancer. In G. Christ, C. Messner & L. Behar (Eds.), Handbook of oncology social work (pp. 507-519). New York: Oxford University Press.

Katz, A. (2015). Meeting the need for psychosocial care in young adults with cancer. Pittsburgh, PA: Oncology Nursing Society.

Masterson, K.J., & Tariman, J.D. (2016). Effective transitional therapy for adolescent and young adult patients with cancer: An integrative literature review. Clinical Journal of Oncology Nursing, 20(4), 391-397.