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For adolescents and young adults (AYAs, 12–24 years), a parental cancer diagnosis can disrupt critical developmental processes and family relationships, negatively impacting wellbeing. However, few supportive interventions are available to affected offspring. This paper reports the feasibility and acceptability of Truce, an Acceptance and Commitment Therapy (ACT)-based weekly program for AYAs impacted by parental cancer. A multi-method, multi-informant approach was used, with data drawn from facilitator, AYA and parent/caregiver feedback collected after each session and at the end of the program. Truce was delivered with high fidelity to the program manual and high participant interest. AYAs and parents/caregivers reported perceived benefits of participation around therapeutic teachings, peer connection, and parental participation. While subsequent work will determine whether Truce has significant psychosocial benefits for participants, findings are a promising indicator of the potential for ACT-based group interventions to support AYAs affected by parental cancer. • Truce is a new supportive intervention for young people impacted by parental cancer. • This study evaluates feasibility and acceptability of the program across 21 groups. • Facilitators reported Truce was delivered with high fidelity to the program manual. • Participating young people and caregivers reported high interest in the program. • They reported benefits of therapeutic teachings, peer support and family involvement. [ABSTRACT FROM AUTHOR]

Purpose: Fertility is a major concern for adolescents and young adults (AYAs, 15–30 years) diagnosed with cancer, yet they often report a lack of information and understanding about fertility impacts and preservation options. This study aimed to evaluate the acceptability and preliminary efficacy of Maybe Later Baby (MLB), an oncofertility information resource for AYAs diagnosed with cancer. Methods: In a randomized controlled trial, 13 participants received MLB alone and 10 received an augmented intervention involving an additional consultation with a health care professional (HCP). Pre- and postintervention surveys and interviews explored participants' well-being, fertility knowledge, health literacy, and experiences using the resource. Results: Participants indicated that the resource was accessible and understandable and provided valuable information without increasing distress. When averaged across conditions, functional health literacy (p = 0.006) and oncofertility knowledge (p = 0.002) increased, although there were no significant changes in fertility-related emotions (p > 0.05), and quality of life decreased (p = 0.014). While qualitative accounts suggested that HCP consultations were useful and validated participants' experiences and concerns, participants receiving the augmented intervention became more nervous/fearful about fertility treatment (p = 0.005). There were no other differences in outcomes between conditions. Conclusions: Young people diagnosed with cancer want and value information about oncofertility and resources such as MLB are acceptable and useful means of providing this information. This could be supplemented by clinical discussion to ensure that tailored situation-specific information is provided and understood and patient distress is appropriately managed. Clinical Trial Registration number: 12615000624583. [ABSTRACT FROM AUTHOR]

Truce is an Acceptance and Commitment Therapy group program for young people who have a parent with cancer. In a pragmatic controlled trial, we compared Truce with a wait-list condition to assess its effect on unmet needs and distress. We also investigated how process variables—mindfulness, cognitive inflexibility, family functioning, and life events—might influence outcomes. Participants' unmet needs improved over time (β^ = −5.01, SE = 16.48, p = 0.036, effect size = 0.42), and those improvements were greater for the intervention group compared to controls (β^ = −5.03, SE = 2.41, p = 0.040, effect size = 0.29). There was no evidence of a significant program benefit for distress. For the intervention group, greater improvements in unmet needs were associated with higher baseline distress (t = 2.36, df = 47, p = 0.022), and being less mindful at baseline (t = 2.07, df = 47, p = 0.044). No significant mediators were identified. For the control group only, experiencing negative/mixed life events related to cancer was a significant moderator of improvement (t = −2.36, df = 33, p = 0.024). Truce appears to offer therapeutic benefits to young people who have a parent with cancer, over and above the expected adjustment to the situation over time. The program seems to buffer the impact of negative cancer-related life events on participants' well-being, but the mechanisms of change remain unclear. • Truce is a new ACT-based program for young people impacted by parental cancer. • This pragmatic controlled trial compares program outcomes to a wait-list control. • Truce participants experienced greater improvements in unmet needs than controls. • Those with higher distress or lower mindfulness experienced greater benefits. • Truce appears to buffer the impacts of negative cancer-related life events. [ABSTRACT FROM AUTHOR]

Objective: Routine psychosocial screening and assessment of people diagnosed with cancer are crucial to the timely detection of distress and provision of tailored supportive care; however, appropriate screening tools have been lacking for adolescents and young adults (AYAs), who have unique needs and experiences. One exception is the recently validated AYA Psycho-Oncology Screening Tool (AYA-POST) for use with young people aged 15–29 years, which comprises a distress thermometer and age-specific needs assessment. This study investigates the clinical utility of this measure, as well as the subsequent service responsiveness within the Australian Youth Cancer Services. Method: In total, 118 AYAs and 29 healthcare professionals: (HCPs) completed surveys about the clinical utility of the AYA-POST; a subset of 30 AYAs completed a 3-month follow-up survey assessing service responsiveness. Descriptive statistics (frequencies/means) were computed for all items, with chi-square analyses used to explore whether perceived clinical utility varied with AYA age, AYA sex, HCP discipline or HCP length of time using the AYA-POST. Results: Participants' responses demonstrate high levels of satisfaction with the tool, evidencing its appropriateness, practicability and acceptability. Moreover, the AYA-POST was reported to facilitate communication about psychosocial needs and prompt referrals, indicating good service responsiveness. Ratings of clinical utility did not differ significantly between AYA and HCP groups. Conclusion: This study demonstrates that the AYA-POST is an appropriate tool in the psychosocial screening of AYAs with cancer, facilitating the identification of distress and unique concerns in this population and valuable in triaging and tailoring care for young cancer patients. [ABSTRACT FROM AUTHOR]

Abstract Background A cancer diagnosis is 2.9 times more likely to occur during the adolescent and young adult years than in younger children. This spike in incidence coincides with a life stage characterised by psychological vulnerability as young people strive to attain numerous, critical developmental milestones. The distress young people experience after cancer treatment seriously jeopardises their ability to move into well-functioning adulthood. Methods/Design This article presents the protocol of the Recapture Life study, a phase II three-arm randomised controlled trial designed to evaluate the feasibility and efficacy of a new intervention in reducing distress and improving quality of life for adolescent and young adult cancer survivors. The novel intervention, “ReCaPTure LiFe” will be compared to a both a wait-list, and a peer-support group control. Ninety young people aged 15–25 years who have completed cancer treatment in the past 1–6 months will be recruited from hospitals around Australia. Those randomised to receive Recapture Life will participate in six, weekly, 90-minute online group sessions led by a psychologist, involving peer-discussion around cognitive-behavioural coping skills (including: behavioural activation, thought challenging, communication and assertiveness skills training, problem-solving and goal-setting). Participants randomised to the peer-support group control will receive non-directive peer support delivered in an identical manner. Participants will complete psychosocial measures at baseline, post-intervention, and 12-months post-intervention. The primary outcome will be quality of life. Secondary outcomes will include depression, anxiety, stress, family functioning, coping, and cancer-related identity. Discussion This article reviews the empirical rationale for using group-based, online cognitive-behavioural therapy in young people after cancer treatment. The potential challenges of delivering skills-based programs in an online modality are highlighted, and the role of both peer and caregiver support in enhancing the effectiveness of this skills-based intervention is also discussed. The innovative videoconferencing delivery method Recapture Life uses has the potential to address the geographic and psychological isolation of adolescents and young adults as they move toward cancer survivorship. It is expected that teaching AYAs coping skills as they resume their normal lives after cancer may have long-term implications for their quality of life. Trial Registration ACTRN12610000717055

Purpose: This study examined Adolescent and Young Adult (AYA) cancer patients' experiences with friends and cancer friends (peers) throughout their cancer journey. Research approach: Qualitative, thematic analysis. Participants: Twelve AYA diagnosed with cancer, treated within the past five years. Methodological approach: Individual semi-structured interviews, focusing on friend and peer experiences pre-/post-diagnosis, during and after treatment. Findings: Overarching themes of 'valued' vs. 'challenging' aspects with friends and peers. Interpretation: Friend and peer relationships were both valuable, but in different ways. Friends provided general support and helped AYA feel like a normal teenager, while peers provided targeted support and helped AYA feel like a normal teenager with cancer. Peers had an intimate understanding of cancer, whereas poor understanding by friends led to further challenges such as avoidance and being dismissive. Peer relations were notably challenged by a premature confrontation with mortality. Friendships evolved and changed throughout the cancer journey. [ABSTRACT FROM AUTHOR]

The I Life Imprint i session is a key therapeutic session in I Good Grief i conceptualised by YP reading and reflecting on a structured letter about the shared values between them and their deceased family member. A family member or close friend (chosen by the YP) was asked to write a I Life Imprint i letter for the YP prior to I Good Grief i , guided by four questions (see Figure). At the end of the I Life Imprint i session, Facilitators completed a session fidelity measure, and YP and Facilitators rated YP's engagement. YP were "reassured" that their family member lived on through them, creating meaning from the death and shaping how the YP moved forwards positively in their grief. [Extracted from the article]

• Leadership offers youth impacted by cancer critical developmental opportunities. • Youth leadership also improves relevance and appropriateness of youth services. • Best practices for engaging and supporting young leaders remain unclear. • A Youth Leadership Framework was co-designed in a youth cancer organisation. • The development process and insights may be instructive for other youth services. Engaging young people in organisational leadership offers opportunities for them to contribute and make a positive difference to their communities, benefitting both the young people and the organisations with which they are involved. However, best practices for engaging and supporting young leaders in cancer support organisations remain unclear. This article reports on the co-design and implementation of a Youth Leadership Framework within a national not-for-profit youth cancer organisation. Staff and young people worked together to develop a Framework which includes a model of youth leadership, defined roles and pathways, a resource toolkit and a suite of age-appropriate leadership development programs. This Framework better enables the organisation to fulfil its long-held goals of supporting, developing and empowering young leaders. This account of the Framework's development and the insights gained in the implementation process serves as an exemplar to other community organisations and health services seeking to engage and support young leaders, expanding the evidence base on best practices in youth leadership in the cancer context. [ABSTRACT FROM AUTHOR]

Simple Summary: A cancer diagnosis during adolescence or young adulthood presents unique medical and psychosocial challenges which must be addressed in the provision of quality, comprehensive cancer care. Tailoring services to the needs of this population requires careful work to identify, monitor and evaluate areas of care; however, published work in this area to guide service priorities is limited. This paper presents work done by the Australian Youth Cancer Services to operationalise and deliver quality care to adolescents and young adults with cancer, focusing on nationally coordinated service improvement initiatives and activity data collection in four areas that are of particular concern to young people diagnosed with cancer: clinical trial enrolment, oncofertility, psychosocial care and survivorship. This account may be instructive for health services seeking to improve the delivery and monitoring of cancer care provided to adolescents and young adults. Adolescents and young adults (aged 15–25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016–17 and 2019–20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults. [ABSTRACT FROM AUTHOR]

The impact of a young person's cancer diagnosis extends to siblings, yet support services to address siblings' needs are limited. This study explores healthcare professionals' (HCPs') perspectives on engaging and supporting adolescent and young adult (AYA, 12–25 years) siblings of young cancer patients in hospital settings. Semi‐structured interviews with nine HCPs explored participants' views on models of care, engagement and assessment of siblings, available services, barriers to care, and future directions. Participants understood the impact of cancer and need to support AYA siblings, but were unclear how these responsibilities fit in with existing models of care and clinical roles. Siblings' absence from hospitals complicated processes of engagement, assessment and provision of care, challenging some participants to engage siblings outside the clinical context. In the absence of direct contact, HCPs largely relied on patients and parents to report or refer siblings for care. Service and resource limitations further restricted the provision of support to siblings. Despite HCPs' recognition of the need to support siblings, their "invisibility," lack of standardised assessment and service constraints complicate the provision of care in hospital settings. Integrating hospital‐based care with community services may better facilitate the engagement and support of AYA siblings. [ABSTRACT FROM AUTHOR]

Background: Adolescent and young adults with cancer are at increased risk of psychosocial difficulties relative to their healthy peers. Current models of inpatient face-to-face psychosocial care might limit the capacity for clinicians to provide timely and personalized assessment and intervention for this group. Telehealth offers a promising alternative toward increasing access to the provision of evidence-based psychosocial assessment and treatment for adolescent and young adults with cancer. Objective: This pilot study aimed to assess the feasibility and acceptability for both patients and clinicians of providing a psychosocial assessment via telehealth to adolescents and young adults currently receiving treatment for cancer, relative to face-to-face delivery. Methods: We included patients who were aged 15-25 years, currently receiving treatment, could speak English well, and medically stable. Patients were recruited from oncology clinics or wards from 5 hospitals located across Sydney and Canberra, Australia, and allocated them to receive psychosocial assessment (Adolescent and Young Adult Oncology Psychosocial Assessment Measure) with a clinical psychologist or social worker through face-to-face or telehealth modalities using a partially randomized patient preference model. Patients completed a pre- and postassessment questionnaire comprising validated and purposely designed feasibility and acceptability indices, including the impact of technical difficulties, if patients had their own devices; number of patients who were content with their group allocation; self-reported preference of modality; Treatment Credibility and Expectations Questionnaire; and Working Alliance Inventory. Clinicians also completed a postassessment questionnaire rating their impressions of the acceptability and feasibility of intervention delivery by each modality. Results: Of 29 patients approached, 23 consented to participate (response rate: 79%). Participants were partially randomized to either telehealth (8/23, 35%; mean age 16.50 years, range 15-23 years; females: 4/8, 50%) or face-to-face (11/23, 62%; mean age 17 years, range 15-22 years; females: 8/11, 72%) conditions. Four participants withdrew consent because of logistical or medical complications (attrition rate: 17.4%). Most participants (6/8, 75%) in the telehealth group used their computer or iPad (2 were provided with an iPad), with minor technical difficulties occurring in 3 of 8 (37.5%) assessments. Participants in both groups rated high working alliance (Working Alliance Inventory; median patient response in the telehealth group, 74, range 59-84 and face-to-face group, 63, range 51-84) and reported positive beliefs regarding the credibility and expectations of their treatment group. Postassessment preferences between face-to-face or telehealth modalities varied. Most patients in the telehealth group (5/8, 63%) reported no preference, whereas 6 of 11 (55%) in the face-to-face group reported a preference for the face-to-face modality. Conclusions: Telehealth is acceptable as patient comfort was comparable across modalities, with no significant technological barriers experienced. However, patients varied in their preferred interview modality, highlighting the need to tailor the treatment to patient preference and circumstances. [ABSTRACT FROM AUTHOR]

Objectives To i) identify and synthesise evidence published since 2007 regarding the impact of parental cancer on adolescent and young adult offspring, ii) identify methodological and evidence gaps addressed during this period and iii) highlight those requiring further attention. Design A systematic review and thematic synthesis of peer reviewed literature regarding the impact of parental cancer upon AYA offspring. Data sources Online searches of CINAHL, Embase, Medline, PsychInfo and Scopus databases were conducted. Reference lists of included articles were screened and additional searches by prominent authors were performed. Review methods Study selection, data extraction and quality analysis was undertaken by three independent researchers. Extracted study data was iteratively reviewed and discussed to achieve consensus regarding thematic synthesis of included studies. Results Database and hand-searching yielded 1730 articles, 54 of which were included in the final synthesis. Included studies are discussed with respect to the following themes: i) study design and quality; ii) measurement and sampling; iii) positive and negative aspects of parental cancer; iv) needs; v) communication and information; vi) coping strategies; vii) interventions; and viii) family functioning and other predictors. Twenty-nine studies reported negative impacts related to parental cancer, while eight identified positive outcomes related to post-traumatic growth. Five returned null or mixed findings. Unmet needs were frequently explored and a new validated measure developed. Communication and information were particularly important for offspring, though these needs were often unmet and parents wanted guidance regarding discussions with their children. Offspring may adopt a variety of coping strategies, some of which appear maladaptive, and may cycle between different approaches. Few evaluations of interventions were identified, and further work in this area is needed. Further evidence has emerged that poorer family functioning and other family and illness-related factors predict worse psychosocial outcomes for offspring, however evidence for other predictors such as age and gender remain mixed. Conclusions Additional evidence for the negative psychosocial impact of parental cancer on adolescent and young adult offspring, their needs, and factors predicting psychosocial outcomes has emerged in the last decade. However, substantial gaps and methodological issues remain and evidence for the development, efficacy or implementation of interventions for this population is very limited. There is also a clear need for greater focus on bereaved and young adult offspring and those from non-western cultural groups, who remain under-represented in research conducted to date. [ABSTRACT FROM AUTHOR]