Rosenberg Abby R, Fladeboe Kaitlyn M, Zhou Chuan, Bradford Miranda C, Kang Tammy, Maurer Scott, Freyer David R, Baker K Scott, Comiskey Liam, Junkins Courtney C, Taylor Mallory R, Yi-Frazier Joyce P
Department of Supportive Oncology, Dana-Farber Cancer Institute, Boston, MA.
Department of Pediatrics, Boston Children's Hospital, Boston, MA.
JCO Oncol Pract. 2025 Apr 28:OP2500161. doi: 10.1200/OP-25-00161.
Adolescents and young adults (AYAs) with advanced cancer (AC) report poor quality of life (QOL), high psychological distress, and minimal engagement in health care discussions. We assessed the effect of a novel resilience coaching program (Promoting Resilience in Stress Management [PRISM]-AC) on AYA outcomes.
We conducted a multisite randomized trial of PRISM-AC versus usual care (UC) among AYAs age 12-24 years, diagnosed with AC within 2 weeks before enrollment. PRISM-AC consists of four sessions targeting AYA-endorsed resilience resources (stress management, goal-setting, cognitive reframing, and meaning-making) plus a session integrating elements of advance care planning. Participants completed surveys at baseline, and 3, 6, 9, and 12 months. The primary outcome was Pediatric QOL at 3 months; secondary/exploratory outcomes included 3-month changes in resilience (10-item Connor-Davidson Resilience Scale) and hope (Snyder Hope Scale), and trajectories of QOL, anxiety, and depression (Hospital Anxiety and Depression Scale) over 12 months. We examined associations with linear mixed effects regression models. We also explored PRISM-AC's impact on AYA participation in critical health care discussions, as documented in the electronic health record.
Between April 2019 and January 2024, we enrolled 239 AYAs (56% of 426 approached) and randomly assigned 195 (82% of enrolled; 96 UC, 99 PRISM). They were of mean age 16.5 years (standard deviation, 3.9), mostly White (63%), non-Hispanic (59%), and publicly insured (53%). At 3 months, we detected no significant differences between groups with respect to QOL, anxiety, or depression; PRISM-AYAs demonstrated greater improvements in resilience (+1.3 [5.9] -1.4 (7.5); = .038) and hope (+2.4 [10.4] -2.8 [11.2]; = .001) than UC-AYAs. Over the 12-month study period, PRISM-AYAs reported more improvements in QOL and anxiety, with significant differences at later time points (PRISM-QOL improvements, 6 months: +3.4 [95% CI, 0.1 to 6.6]; = .043; 12 months: +6.8 [95% CI, 3.3 to 10.3]; < .001). Although participation in key health care discussions was similar between groups from baseline to 6 months, 67% (95% CI, 35 to 88) and 50% (95% CI, 22 to 78) of PRISM-AYAs participated at 9 and 12 months, respectively, compared with 39% (95% CI, 20 to 61) and 38% (95% CI, 21 to 59) of UC-AYAs.
Among AYAs with AC, PRISM-AC did not immediately improve QOL. Rather, it improved resilience and hope, potentially enabling longer-term improvements in QOL.
患有晚期癌症（AC）的青少年和青年（AYA）报告生活质量（QOL）较差、心理困扰严重且很少参与医疗保健讨论。我们评估了一种新型的复原力辅导计划（压力管理中的促进复原力[PRISM]-AC）对AYA结局的影响。
我们在12至24岁、在入组前2周内被诊断为AC的AYA中进行了一项多中心随机试验，比较PRISM-AC与常规护理（UC）。PRISM-AC包括针对AYA认可的复原力资源的四个环节（压力管理、目标设定、认知重构和意义构建），外加一个整合了预先护理计划要素的环节。参与者在基线时以及3、6、9和12个月时完成调查。主要结局是3个月时的儿童生活质量；次要/探索性结局包括3个月时复原力（10项Connor-Davidson复原力量表）和希望（Snyder希望量表）的变化，以及12个月内生活质量、焦虑和抑郁（医院焦虑和抑郁量表）的轨迹。我们使用线性混合效应回归模型检查相关性。我们还探讨了PRISM-AC对AYA参与关键医疗保健讨论的影响，这在电子健康记录中有记录。
在2019年4月至2024年1月期间，我们招募了239名AYA（占426名目标人群的56%），并随机分配了195名（占招募人数的82%；96名UC，99名PRISM）。他们的平均年龄为16.5岁（标准差3.9），大多为白人（63%）、非西班牙裔（59%）且有公共保险（53%）。在3个月时，我们未发现两组在生活质量、焦虑或抑郁方面有显著差异；与UC-AYA相比，PRISM-AYA在复原力（+1.3[5.9]对-1.4[7.5]；P=.038）和希望（+2.4[10.4]对-2.8[11.2]；P=.001）方面有更大改善。在12个月的研究期间，PRISM-AYA报告在生活质量和焦虑方面有更多改善，在后期时间点有显著差异（PRISM生活质量改善，6个月：+3.4[95%CI，0.1至6.6]；P=.043；12个月：+6.8[95%CI，3.3至10.3]；P<.001）。尽管从基线到6个月两组参与关键医疗保健讨论的情况相似，但PRISM-AYA分别有67%（95%CI，35至88）和50%（95%CI，22至78）在9个月和12个月时参与，而UC-AYA分别为39%（95%CI，20至61）和38%（95%CI，21至59）。
在患有AC的AYA中，PRISM-AC并未立即改善生活质量。相反，它改善了复原力和希望，可能使生活质量在长期内得到改善。
