Grant Details
Grant Number: |
5R01CA269574-03 Interpret this number |
Primary Investigator: |
Rosenberg, Abby |
Organization: |
Dana-Farber Cancer Inst |
Project Title: |
Promoting Resilience in Early Survivorship Among Adolescents and Young Adults with Cancer |
Fiscal Year: |
2024 |
Abstract
PROJECT SUMMARY
Adolescents and early Young Adults (AYAs, 12-25 years-old) with cancer are at high risk of poor psychosocial
outcomes because their distinct developmental challenges add to the burden of cancer. This is particularly true
when AYAs transition from active treatment to cancer-surveillance (“early survivorship”) because this time
demands increasing autonomy, re-integration into social, educational/vocational networks, and re-evaluation of
self-identity. We created “Promoting Resilience in Stress Management” (PRISM): a novel, brief, skills-based
program promoting AYA-endorsed “resilience resources” (stress-management, goal-setting, positive-reframing,
and meaning-making). PRISM involves 4, 30-60 minute telehealth sessions between AYAs and certified
PRISM coaches, plus an award-winning smartphone app. In a phase 2 randomized trial of 92 AYAs receiving
cancer-treatment, PRISM improved patient-reported resilience, quality of life, hope, benefit-finding, and
psychological distress early after its delivery, compared to usual care. While these findings were promising,
they were tempered by 3 key threats to PRISM’s scalability: (1) PRISM’s delivery demands scarce human
resources that might be replaced by digital media; (2) PRISM’s durability was limited after the study ended;
and, (3) we lacked tools to recognize real-time changes in AYA distress that warranted additional support.
Thus, we now propose a multi-center, Sequential, Multiple Assignment, Randomized Trial (SMART) to address
these 3 barriers among AYA survivors of cancer. Specifically, we aim to: (1) Evaluate the efficacy of video-
and text-PRISM coaching vs. the self-guided mPRISM app; (2) Determine the optimal method for
maintenance of PRISM-response; and (3) Explore correlations between patient-reported resilience,
distress, hope, quality of life, anxiety, and depression with validated instruments and: (a) in-app
resilience and stress ratings, and (b) digital phenotype (passive smart-phone data including phone/text
logs and accelerometer data). With SMART design, N=325 English or Spanish speaking AYAs from 3 diverse
U.S. regions (Northwest/Alaska/Hawaii, Midwest, and South) who completed cancer-directed therapy within
the past 2 years will be randomized 1:2:2 first to receive app-only, video, or text-based PRISM lay-coaching.
Responders in the video- and text- arms will be randomized 1:1 second to app-only (low) maintenance or text-
based (high) maintenance. Because non-response suggests a demand for more in-person engagement, text
non-responders will be non-randomly assigned to video, and video non-responders will receive referrals to
specialty care. Exploratory analyses will evaluate the role of in-app and digital phenotypic data in detecting
real-time AYA distress. This proposal is significant because early survivorship is highly stressful for AYAs with
cancer, and we propose a scalable, evidence-based program to support AYA resilience. Findings will facilitate
an accessible, sustainable, evidence-based program designed to target and meet the needs of thousands of
AYAs, in turn alleviating the burdens of cancer survivorship and improving their quality of life.
Publications
Indicators of developmental status among adolescents and young adults with cancer: Perceived adult status, social milestones, and health-related quality of life.
Authors: Fladeboe K.M.
, Siembida E.J.
, Ip E.
, Rosenberg A.R.
, Snyder M.A.
, Salsman J.M.
.
Source: Psycho-oncology, 2023 Sep; 32(9), p. 1363-1371.
EPub date: 2023-06-28 00:00:00.0.
PMID: 37381114
Related Citations
"I won't get to live my life the way I planned it": A qualitative analysis of the experiences of adolescents and young adults with advanced cancer.
Authors: Barton K.S.
, Steineck A.
, Walsh C.A.
, Lau N.
, O'Donnell M.B.
, Rosenberg A.R.
.
Source: Pediatric Blood & Cancer, 2023-07-12 00:00:00.0; , p. e30554.
EPub date: 2023-07-12 00:00:00.0.
PMID: 37438862
Related Citations