Cancer diagnoses affect an estimated 70,000 adolescents and young adults (AYAs) annually, yet few cancer treatment and survivorship programs exist that specifically address their unique needs. AYAs have specific challenges that affect their health during and after cancer, such as low physical activity (PA), poor diet, and substance abuse, but these factors can be difficult to address because of a practice gap for AYAs: they do not fit neatly into either adult or pediatric oncology settings. In fact, the National Cancer Institute has identified this as a health disparity requiring special attention.
To address the challenges, the Institute of Medicine and Livestrong Foundation coordinated a workshop about the needs of AYA survivors and potential strategies to improve their quality of care. Daniel et al. summarized the outcomes of the workshop in an article in the December 2015 issue of the Clinical Journal of Oncology Nursing.
AYA Lifestyle Risks and Challenges
Because AYAs with cancer are at increased risk for health problems and premature death both during cancer and in the future, Daniel et al. noted that care providers should encourage the development of health-promoting behaviors that can be directly controlled by survivors, including improved diet, regular physical activity, and reduced substance abuse.
Diet: AYAs are in a critical period of growth where hormones are increased to facilitate muscle and skeletal development, including bone mass volume and density as well as heart and lung size and capacity. Adequate nutrition and PA are necessary to support optimal physical growth and development in AYAs, but cancer can increase nutritional needs even further, Daniel et al. reported.
However, studies have shown that young cancer survivors have unhealthy diets that are high in fat and low in fruits and vegetables. Estimates suggest that 39%–94% of AYA cancer survivors do not meet national recommendations for several nutrients such as calcium, vitamin D, folate, and iron, which are important for cardiovascular health and bone development.
Additionally, AYAs with cancer tend to indulge in excess empty calories, consuming about 10% more energy than they expend daily: more than one-third of AYA survivors who are at a normal weight before diagnosis become overweight by the end of treatment. This puts them at risk for cardiovascular disease, hypertension, and poor general physical health.
Daniel et al. found only two studies of dietary interventions in AYA survivors: one attempted to improve diet quality but had disappointing results, and another tried to increase calcium consumption and was successful at increasing use of calcium supplements but not dietary intake of calcium.
Physical activity: Studies have shown that AYA survivors report lower levels of PA than their healthy counterparts. As many as 52% of adult childhood cancer survivors report not meeting Centers for Disease Control and Prevention PA guidelines, and 31% of AYA survivors report no leisure-time PA. Daniel et al. explained that cancer treatment may be to blame: side effects from treatments may affect lean muscle development causing increased fatigue, diminished coordination, or injury. ONS’s Putting Evidence Into Practice resources have found that PA is effective at decreasing fatigue, improving anxiety and depression, improving sleep quality, maintaining bone and muscle strength, and decreasing risk of cancer recurrence.
Daniel et al. reported that studies have found that the most successful PA interventions in AYA survivors use technologies such as websites, smartphone apps, or social media to promote PA and healthy diets.
Substance abuse: In the general population, peak alcohol and tobacco use usually occurs among AYAs aged 21–25 years and illicit drug use, although less prevalent, in those aged 18–20 years. Studies in survivors of childhood cancer have shown tobacco usage rates of 16%–37%, alcohol usage rates of 50%–90%, cannabis usage rates of 12% (United States) to 20%–49% (Australia), and illicit drug usage rates of 1% (United States) to 7%–24% (Australia).
Daniel et al. noted that substance abuse has particular implications for cancer, including interference with cancer and its treatment and increasing risk for other cancers such as gastrointestinal and breast. The authors found no research about substance abuse interventions in AYAs with cancer outside of tobacco, and they called for additional research into incorporating prevention strategies into treatment and follow-up care.
Implications for Oncology Nurses
Oncology nurses in either pediatric or adult settings may find themselves caring for AYA survivors during treatment, follow-up, and survivorship and need to be aware of the particular challenges and risks for this patient population. Because of the significant amount of time they spend with patients on a day-to-day basis, point-of-care nurses are well positioned to listen to patients’ concerns and to educate and support them. Nurses can provide education and behavior change reinforcement for patients and collaborate with colleagues from other disciplines to meet patients’ needs.
Advanced practice nurses specializing in AYA care can serve as a resource for colleagues who are unfamiliar with AYA needs. Clinical nurse specialists can manage transitions in care and advocate for including lifestyle behaviors in survivorship care plans.
As previously mentioned, research into certain AYA challenges is lacking. Therefore, nurse scientists will have the opportunity to investigate effective approaches that integrate patients’ developmental stages and age-appropriate education and behavior interventions, often through the use of technology or social media.
Five-Minute In-Service is a monthly feature that offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Needs and Lifestyle Challenges of Adolescents and Young Adults With Cancer: Summary of an Institute of Medicine and Livestrong Foundation Workshop,” by Casey L. Daniel, PhD, MPH, Karen M. Emmons, PhD, Karen Fasciano, PsyD, Brenda Nevidjon, MSN, RN, FAAN, Bernard F. Fuemmeler, PhD, MPH, and Wendy Demark-Wahnefried, PhD, RD, which was featured in the December 2015 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.