Role of Nurses in Addressing Psychosocial Needs of Young Adults With Cancer

Anne Katz, RN, PhD

As part of our coverage of the Oncology Nursing Society (ONS) 40th Annual Congress, held April 23–26 in Orlando, Florida, we are speaking with Anne Katz, RN, PhD, a clinical nurse specialist at Cancer Care Manitoba. Dr. Katz will be speaking at this year’s ONS Congress on some of the psychosocial challenges faced by young adults with cancer.

-Interviewed by Leah Lawrence 

Cancer Network: Dr. Katz, thank you for speaking with us today. First, tell us a little bit about the population of young adults. How is this population defined and what makes them unique when it comes to cancer care?

Dr. Katz: Young adults are regarded as those between the ages of 19 and 35. This is a really important development stage, with those at the lower end (19-, 20-year-olds) really starting out their independent life from their family of origin, and then on the other end (34-, 35-year-olds), these are people with their own families, their own responsibilities, and established careers. There is a lot going on in this age group.

Cancer Network: In the cancer field, what are some of the typical psychosocial issues addressed by health professionals when it comes to cancer care?

Dr. Katz: One of the challenges of caring for people in this age group, these young adults, is that sometimes they have cancers that are more often found in pediatric populations, so they may be treated in a pediatric setting. Sometimes they have cancers found in older populations-where most cancers are found- so they are treated in adult settings. You can imagine a 19-year-old in a unit with predominantly 65- to 70-year olds-there are going to be problems.

One of the challenges here is to ensure that young adults with cancer are getting the psychosocial care they need, and depending on their treatment setting they might not have those needs met, which is one of the reasons why I wrote this book called Meeting the Needs of Psychosocial Care in Young Adults with Cancer.

Cancer Network: What specific psychosocial challenges might young adults with cancer face that are different from those faced by adults or children?

Dr. Katz: Young adults are often at the beginning of their career. Or they may be in college or just starting out in their field of expertise. They may be just experimenting with relationships and dating. Certainly this is a time where they are separating from their parents, becoming more independent and there are, of course, issues around sexuality and threats to fertility from treatment. These are all important psychosocial issues that need to be addressed and that really are different from the usual population that we see with cancer, those aged 65 and older.

Cancer Network: Putting this in context of the ONS Congress, how can nurses or health professionals screen young adults for these psychosocial issues?

Dr. Katz: The first thing is to ask. Recognize that young adults have specific needs for psychosocial care and specific unmet needs related to their age of development, and to ask about it. There are no screening tools that are specific for young adults. Certainly we have tools to screen for distress, for example, which is a really important focus of nursing and oncology care today, and more than that we really do need to be aware of the issues that these young people face, and we need specialized care to deal with these issues.

Think for a moment, I will give you an example of a young adult, perhaps a 19- or 20-year-old young man who is hospitalized for treatment. If he is in a pediatric unit, there are going to be cartoon characters on the walls. There are going to be parents caring for their children who are admitted. Meals are probably going to be early in the evening because small kids need to go to sleep early, and they are not going to encourage visitors probably after 7 o’clock at night. The staff may frown if this young man has friends coming to visit or listening to music or watching TV late at night. Those are significant challenges.

A different side of the coin may happen if he is in a unit with much older patients who are not going to be happy about people visiting late at night, or when he wants to watch television or sleep late, this often doesn’t go down well with staff who want to get busy with their day when they come on shift.

We need to know about this and to be aware that this age group is different, that they face different challenges, and we need to be educated and conscious of the changes that we need to make in our culture of care to best meet their needs.

Cancer Network: What then are some of those methods that can help young adults to cope with psychosocial challenges and changes that they might have after cancer treatment?

Dr. Katz: One of most important issues is peer support. Very often these young people have never met anybody with cancer, don’t know anybody even in their family of their age who have cancer, and they feel isolated and alone, and feel like they are the only people in the whole wide world this has happened to. Support groups are really important. Today we have a number of support groups both in the United States and in Canada with a strong online presence, so you don’t have to physically be in touch with other young adults. Think, for example, of someone who lives in rural area or a smaller town, there may not be anybody else close to them whom they can connect with. Through online support groups, such as Stupid Cancer, they can get in touch, not only with other young adults with cancer, but young adults with the same kind of cancer that they have.

The other thing we need to do is provide appropriate psychosocial support from psychosocial clinicians, psychologists, etc, so that their needs are met and assessed. Perhaps the most important thing of all is don’t assume that you know what is going on for this young person. Ask. Don’t be afraid to address sensitive topics like sexuality, threats to fertility, what is happening in their social circles. Just ask and they will tell you what they need.

Cancer Network: Well thank you for taking a few minutes to discuss this important topic with us.

Dr. Katz: You’re very welcome.