Considerations for Young Adults with Cancer

TON September 2015 Vol 8 No 5

Young adults (YA) with cancer are a unique population with special needs. Nurses can play an important role in addressing the psychosocial needs, as well as the physical needs, of this population, according to Anne Katz, RN, PhD, clinical nurse specialist at CancerCare Manitoba in Winnipeg, Canada, and the author of several books on sexuality and cancer, who spoke on this subject at the 2015 annual meeting of the Oncology Nursing Society.

“I want you to go back to your practice with the idea on your radar that YA are a unique population with unique needs,” she told listeners. “Three things are important in dealing with them: communication, communication, communication.”

Young adulthood is a time of multiple developmental tasks that relate to study and career, separating from parents, developing relationships, determining sexual preferences, and deciding whether or not to have children, she continued. Katz noted that the definition for young adulthood varies. For this presentation, she defined the age range as 15 to 39 years.

Because of patient and healthcare factors, YA with cancer often experience a significant diagnostic delay and are diagnosed with more advanced cancers. Patient factors include lack of awareness, minimizing symptoms, fear of embarrassment, or not being seen as manly. The YA population may lack parental involvement and may not have a primary care provider. Doctors may have a low index of suspicion in YA, partly owing to the rarity of cancers in this age group and lack of awareness of which cancers affect them.

“Nurses need to be aware of what cancers occur in YA and take the concerns of patients who present with symptoms seriously,” she stated.

Once a diagnosis is made, YA should be involved in decision-making regarding their treatment, which can encompass some unique issues. They are typically treated with higher doses of chemotherapy than are adults, and toxicities can affect sexual function, body image, and relationships.

Multidisciplinary Approach

“The consensus is that YA with cancer need to be cared for by multidisciplinary teams with special expertise,” she stated.

Successful transitions in cancer care rely on good communication between teams and detailed care pathways defined by needs of the patient. The oncology team should follow the YA patient for at least a year after treatment is completed. The patients’ needs and preferences should be included in their survivorship plan.

YA with cancer often lag behind their peers and may require continued supportive care. Peer support is even more important for YA than other age groups. Several online support groups can help with return to work or school.

Nurses should have a permissive attitude toward YA with cancer, taking into consideration their developmental stage, and view patients as allies. Provide patients with choices, Katz suggested. Find ways to help the YA achieve control, for example, in the clothes they wear and what time they take their medications.

“Dating is a sentinel milestone for YA. Cancer puts a halt to social life, and causes tremendous stress if a patient is in a relationship,” she continued.

“YA are forming their identity, which involves thinking about sexual identity. “Often cancer becomes your identity,” Katz said.

Contraception counseling should not be neglected, she continued. Open communication is important. Cancer treatments can affect body image, sexuality, and function. “This is about them. Do not put your beliefs or judgments on the table. All adults should be encouraged to practice safe sex,” Katz stated.

Gender identity is a neglected area for YA with cancer. There is nothing in the literature to guide how to support gays, lesbians, bisexuals, or transgenders, Katz said.

“Use neutral language when discussing relationships and sexuality, and refrain from using platitudes,” she suggested. “Be honest. YA have bulls--t detectors.”

Sometimes YA need advice or guidance on how and when to disclose cancer to their partner or friends. Nurses can help them practice how to tell their partners and friends, and help them figure out how much or how little to disclose.

“Some good advice is to tell them to just say ‘I have cancer’ and see what the response is before saying more,” she said.

Reference
Katz A. Psychosocial challenges for the young adult with cancer—how can we help? Presented at: Oncology Nursing Society 40th Annual Congress; April 22-26, 2015; Orlando, FL.

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