Overcoming unique challenges faced by young adults with cancer

A Q&A with Karen Fasciano, clinical psychologist at the Dana-Farber Cancer Institute, highlights the challenges and progress in treating the non-medical issues young adults with cancer face during and after treatment. "Young adults have unique needs when coping with cancer," says Karen Fasciano, clinical psychologist and director of the Dana-Farber Cancer Institute's Young Adult Program in Boston. Her training and experience working in both the pediatric and young adult cancer settings bring a dual perspective to her work. "I can bring my clinical skills to each encounter but also the wisdom I have gained from each young person who has honestly shared their cancer journey."CURE asked Fasciano a few questions about her work with young adults, a group defined as those diagnosed with cancer between the ages of 18 and 39; however, the program evaluates anyone who identifies themselves as a "young adult" to see if it is a right fit for them. CURE: What are some of the emotional and psychological issues you see in young adults diagnosed with cancer?Fasciano: Young adults (YAs) often experience disruptions in many areas including: identity, self image, role in family and career and education. Young adulthood is a time when many YAs are exploring both independence and intimacy at the same time as they are trying to assert control over their future goals. Illness can expose young adults coping with cancer to a need for dependence on others, a sense of their own vulnerability, and a struggle with managing the many uncertainties that come along with treatment. YAs also face, many for the first time, the existential distress that comes with a life-threatening illness. Peers may not be struggling with the same issues, so YAs may feel isolated in the processing and sorting out of these complex issues. Life disruptions, for any of us, require recalibration which often comes with emotional distress: anxiety, grief over what has changed and fear.CURE: Are there common issues that young adults with cancer face that they may not be expecting?Fasciano: When diagnosed, most young adults assume that they will want to celebrate at the end of treatment. They don't often expect that they will feel increased distress after cancer treatment is over. While this can be a difficult time for all cancer patients, young adults have some unique challenges. Transitions and changes during the young adult years are many and parts of the YA's environment may have changed by the time treatment concludes (friends have graduated from college while they are returning to finish degrees; entry-level jobs that they were on leave from may not look the same a year or two later). In addition, the life structure and goals the YA had before treatment may not be feasible or desired at the conclusion of treatment. Getting back into a structure and routine and re-evaluating and sometime re-establishing life goals can take longer than the YA expected. Many YAs find that the end of treatment is a time when they process the impact of the cancer and the emotional reaction to the treatment in a different way. Although it is not fully understood why emotions can be so high at this time, my speculation is that without the physical demands of the daily routines of treatment, the YA has more energy to put into their emotional reactions.CURE: What advice would you give in dealing with the emotional and psychological issues newly diagnosed young adults may face during and after cancer?Be conscious of nurturing your personal identity outside of your illness. Your life goals may have been disrupted. Setting short-term goals or focusing on expressions of your values can help.Fasciano: Understand that the emotional demands of cancer require attention. Nurture these needs in the same way you will your physical needs.Think about how you have coped with difficult situations in the past, as this may help you to identify your personal strengths as you cope with this challenge. However, be open to and seek out new coping strategies as the demands of cancer may require a variety of strategies. Challenge yourself to clearly ask for what you need or receive help from others to identify what you need. As supportive as family and friends can be, they need your input. You are your best advocate.Consider peer support from other YAs who have coped with cancer as many find this helpful. CURE: Is it important for young adults with cancer to connect with other young adults in similar situations? Fasciano: Many YAs find peer connections helpful and find that connecting with even one YA who has coped with cancer can help them navigate the experience and feel less alone. Connections can be in person or via social networking. As helpful as these interactions can be, for some YAs, talking or messaging others who have had a different experience with cancer or are in a different place in their treatment process can promote anxiety. Understand that although YAs with cancer share a common experience, it might not the same experience as yours.CURE: What are some of the future directions you see in treating young adults with cancer? What are some advances you predict we'll see in this field? Fasciano: Our YA program is looking at innovative ways to deliver emotional care to the YA population. We are interested in understanding what kind of support is most helpful to YAs and in what effective ways that support can be delivered to this population. We are finding that using technology, social networking and peer support can be an important addition to structured counseling interventions. All YA deserve education and psychological support to address their distress but also to promote resilience and growth.