Restricted accessResearch articleFirst published online 2026-4
Program Delivery and Change in Patient-Reported Outcomes of an Age-Specific Rehabilitation Program for Young Adult Cancer Survivors: A Feasibility Study
This study evaluated the program delivery of a part of the age-specific intervention Young Adult Taking Action (YATAC), a rehabilitation program for young adult cancer survivors, focusing on dose, adherence, fidelity and adaptation. It also explored changes in health-related quality of life, fatigue, depression, anxiety, and loneliness.
Methods:
A one-armed feasibility study with 19 young adult cancer survivors (aged 18–39) involved in a multicomponent rehabilitation program a 5-day residential stay, a 10-week home-based period, and a 2-day follow-up. Program delivery data were collected during the stays, and patient-reported outcomes were assessed at baseline and 10 weeks. Changes were analyzed using the Wilcoxon signed-rank test, and responder analysis assessed minimal clinically relevant changes.
Results:
All sessions were delivered, with 100% of participants completing the five-day and a two-day stay. Adherence and fidelity were both 83%, though 30% of sessions reported time constraints. Significant improvements were observed in cognitive functioning (p = 0.0046), fatigue (p = 0.0066), and anxiety (p = 0.0146). More participants showed minimal clinically relevant improvements in cognitive functioning (63%) than deteriorations. Fatigue was the only outcome with no reported clinically relevant deterioration.
Conclusion:
The tested part of the YATAC program demonstrated feasibility with high adherence and fidelity. Some adjustments to session duration and structure are needed. The program showed potential to improve cognitive function, fatigue, and anxiety, though findings should be interpreted cautiously due to the small sample size and one-armed design.
AlvarezEM, ForceLM, XuR, et al.The global burden of adolescent and young adult cancer in 2019: A systematic analysis for the global burden of disease study 2019. The Lancet Oncology, 2022; 23(1):27–52.
2.
ArnettJJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol, 2000; 55(5):469–480.
3.
ArnettJJ. Conceptions of the transition to adulthood among emerging adults in American ethnic groups. New Dir Child Adolesc Dev, 2003(100):63–75.
4.
MehtaCM, ArnettJJ, PalmerCG, NelsonLJ. Established adulthood: A new conception of ages 30 to 45. Am Psychol, 2020; 75(4):431–444.
5.
CocciaPF, AltmanJ, BhatiaS, et al.Adolescent and young adult oncology. Clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2012; 10(9):1112–1150.
6.
MillerKD, Fidler‐BenaoudiaM, KeeganTH, et al.Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin, 2020; 70(6):443–459.
7.
BleyerA, FerrariA, WhelanJ, BarrRD. Global assessment of cancer incidence and survival in adolescents and young adults. Pediatr Blood Cancer, 2017; 64(9):n/a.
8.
JanssenSHM, van der GraafWTA, van der MeerDJ, et al.Adolescent and Young Adult (AYA) cancer survivorship practices: An overview. Cancers (Basel), 2021; 13(19):4847.
9.
KnoerlR, GrandinettiK, SmenerL, et al.Exploring adolescent and young adult cancer survivors’ experience with cancer treatment-related symptoms: A qualitative analysis of semi-structured interviews. J Adolesc Young Adult Oncol, 2024; 13(4):665–673.
10.
ForbesC, TannerS, EngstromT, et al.Patient reported fatigue among adolescent and young adult cancer patients compared to non-cancer patients: A systematic review and meta-analysis. J Adolesc Young Adult Oncol, 2023.
11.
OsmaniV, HörnerL, KlugSJ, TanakaLF. Prevalence and risk of psychological distress, anxiety and depression in Adolescent and Young Adult (AYA) cancer survivors: A systematic review and meta-analysis. Cancer Med, 2023; 12(17):18354–18367.
12.
LiX, HathawayCA, SmallBJ, et al.Social isolation, depression, and anxiety among young adult cancer survivors: The mediating role of social connectedness. Cancer, 2024; 130(23):4127–4137.
13.
SingerS, KuhntS, ZwerenzR, et al.Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. Br J Cancer, 2011; 105(3):445–451.
14.
VetschJ, WakefieldCE, McGillBC, et al.Educational and vocational goal disruption in adolescent and young adult cancer survivors. Psychooncology, 2018; 27(2):532–538.
15.
BrockH, FriedrichM, SenderA, et al.Work ability and cognitive impairments in young adult cancer patients: Associated factors and changes over time-results from the AYA-Leipzig study. J Cancer Surviv, 2022; 16(4):771–780.
16.
KetterlTG, SyrjalaKL, CasillasJ, et al.Lasting effects of cancer and its treatment on employment and finances in adolescent and young adult cancer survivors. Cancer, 2019; 125(11):1908–1917.
17.
PedersenKJ, BoisenKA, MidtgaardJ, et al.Facing the maze: Young cancer survivors’ return to education and Work-A professional expert key informant study. J Adolesc Young Adult Oncol, 2018; 7(4):445–452.
18.
FardellJE, WakefieldCE, PattersonP, et al.Narrative review of the educational, vocational, and financial needs of adolescents and young adults with cancer: Recommendations for support and research. J Adolesc Young Adult Oncol, 2018; 7(2):143–147.
19.
BecktellK, SimpsonP, PhelanR, et al.Developmental differences in health-related quality of life in adolescent and young adult cancer survivors. Qual Life Res, 2020; 29(9):2435–2444.
20.
HussonO, ZebrackBJ, AguilarC, et al.Cancer in adolescents and young adults: Who remains at risk of poor social functioning over time? Cancer, 2017; 123(14):2743–2751.
21.
HussonO, ZebrackBJ, BlockR, et al.Health-Related quality of life in adolescent and young adult patients with cancer: A longitudinal study. J Clin Oncol, 2017; 35(6):652–659.
22.
SchulteFSM, ChalifourK, EatonG, GarlandSN. Quality of life among survivors of adolescent and young adult cancer in Canada: A Young Adults With Cancer in Their Prime (YACPRIME) study. Cancer, 2021; 127(8):1325–1333.
23.
SenderA, FriedrichM, LeuteritzK, et al.Unmet supportive care needs in young adult cancer patients: Associations and changes over time. Results from the AYA-Leipzig study. J Cancer Surviv, 2019; 13(4):611–619.
24.
LidingtonE, DarlingtonA-S, DinA, et al.Describing unmet supportive care needs among young adults with cancer (25–39 Years) and the relationship with health-related quality of life, psychological distress, and illness cognitions. J Clin Med, 2021; 10(19):4449.
25.
KeeganTHM, LichtensztajnDY, KatoI, et al.; AYA HOPE Study Collaborative Group. Unmet adolescent and young adult cancer survivors information and service needs: A population-based cancer registry study. J Cancer Surviv, 2012; 6(3):239–250.
26.
AdamsSC, HermanJ, LegaIC, et al.Young adult cancer survivorship: Recommendations for patient follow-up, exercise therapy, and research. JNCI Cancer Spectr, 2021; 5(1):pkaa099.
27.
D’AgostinoNM, PenneyA, ZebrackB. Providing developmentally appropriate psychosocial care to adolescent and young adult cancer survivors: Adolescents and young adults with. Cancer: Towards Better Outcomes in Canada. Cancer, 2011; 117(10 Suppl):2329–2334.
28.
AagesenM, la CourK, MøllerJK, et al.Rehabilitation interventions for young adult cancer survivors: A scoping review. Clin Rehabil, 2023; 37(10):1347–1374.
29.
AagesenM, PilegaardMS, HaukenMA, et al.Users’ perspective on rehabilitation interventions for young adult cancer survivors: A group concept mapping study. European J Cancer Care, 2022; 31(6):e13734–en/a.
30.
AagesenM, PilegaardMS, JanssensA, et al.Development of a rehabilitation programme for young adult cancer survivors using co-production. Res Involv Engagem, 2024; 10(1):134.
31.
O’CathainA, CrootL, DuncanE, et al.Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open, 2019; 9(8):e029954-e.
32.
O’CathainA, CrootL, SwornK, et al.Taxonomy of approaches to developing interventions to improve health: A systematic methods overview. Pilot Feasibility Stud, 2019; 5(1):41.
33.
SkivingtonK, MatthewsL, SimpsonSA, et al.A new framework for developing and evaluating complex interventions: Update of medical research Council guidance. BMJ, 2021; 374:n2061–n.
34.
EldridgeSM, ChanCL, CampbellMJ, et al.; PAFS consensus group. CONSORT 2010 statement: Extension to randomised pilot and feasibility trials. Pilot Feasibility Stud, 2016; 2:64.
35.
AagesenM, la CourK, HaukenMA, PilegaardMS. The ‘young adult taking action’ programme for young adult cancer survivors: A study protocol for a feasibility study. Scand J Occup Ther, 2023; 30(8):1472–1488.
36.
RasmussenA, JespersenE, BackmannT, JarlbaekL. Practice Description, Research Clinic REHPA. Standard Residential Rehabilitation Course for People with or After Cancer. REHPA, The Danish knowledge center for Rehabilitation and Palliative care: Nyborg; 2020.
37.
BanduraA. Social cognitive theory: An agentic perspective. Annu Rev Psychol, 2001; 52:1–26.
38.
DeanSG, SiegertRJ, TaylorWJ. Interprofessional Rehabilitation: A Person-Centred Approach. Wiley-Blackwell: Chichester, West Sussex, UK; 2012.
39.
HarrisPA, TaylorR, MinorBL, et al.; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform, 2019; 95:103208.
40.
AaronsonNK, AhmedzaiS, BergmanB, et al.The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993; 85(5):365–376.
41.
RamanS, DingK, ChowE, et al.Minimal clinically important differences in the EORTC QLQ-C30 and brief pain inventory in patients undergoing re-irradiation for painful bone metastases. Qual Life Res, 2018; 27(4):1089–1098.
42.
MusoroJZ, CoensC, SprangersMAG, et al.; EORTC Melanoma, Breast, Head and Neck, Genito-urinary, Gynecological, Gastro-intestinal, Brain, Lung and Quality of Life Groups. Minimally important differences for interpreting EORTC QLQ-C30 change scores over time: A synthesis across 21 clinical trials involving nine different cancer types. Eur J Cancer, 2023; 188:171–182.
43.
MendozaTR, WangXS, CleelandCS, et al.The rapid assessment of fatigue severity in cancer patients. Cancer, 1999; 85(5):1186–1196.
44.
ShahidA, WilkinsonK, MarcuS, ShapiroCM. Brief Fatigue Inventory. STOP, THAT and One Hundred Other Sleep Scales. Springer New York: New York, NY; 2011. p. 75–7.
45.
GunnHJ, ZanilettiI, BreenWG, et al.Establishing the minimal clinically important difference of the brief fatigue inventory for brain or CNS cancer patients undergoing radiotherapy. Neurooncol Pract, 2024; 11(5):633–639.
46.
KroenkeK, SpitzerRL, WilliamsJB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med, 2001; 16(9):606–613.
47.
UllrichA, AscherfeldL, MarxG, et al.Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliat Care, 2017; 16(1):31.
48.
KroenkeK. Enhancing the clinical utility of depression screening. CMAJ, 2012; 184(3):281–282.
49.
HinzA, MehnertA, KocaleventR-D, et al.Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry, 2016; 16:22.
50.
SpitzerRL, KroenkeK, WilliamsJB, LöweB. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med, 2006; 166(10):1092–1097.
51.
ToussaintA, HüsingP, GumzA, et al.Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). J Affect Disord, 2020; 265:395–401.
52.
HinzA, EsserP, FriedrichM, et al.Changes in anxiety in the general population over a six-year period. PLoS One, 2023; 18(9):e0291206-e.
HughesME, WaiteLJ, HawkleyLC, CacioppoJT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Res Aging, 2004; 26(6):655–672.
55.
World Medical Association. World medical association declaration of helsinki: Ethical principles for medical research involving human subjects. JAMA, 2013; 310(20):2191–2194.
56.
HaukenM, LarsenT, HolsenI. “Back on Track”: A longitudinal mixed methods study on the rehabilitation of young adult cancer survivors. J Mixed Methods Res, 2017; 13:155868981769855.
57.
BertheussenGF, KaasaS, HokstadA, et al.Feasibility and changes in symptoms and functioning following inpatient cancer rehabilitation. Acta Oncol, 2012; 51(8):1070–1080.
58.
CormieP, ZopfEM, ZhangX, SchmitzKH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev, 2017; 39(1):71–92.
59.
Sansom-DalyUM, WakefieldCE, EllisSJ, et al.Online, group-based psychological support for adolescent and young adult cancer survivors: Results from the recapture life randomized trial. Cancers (Basel), 2021; 13(10):2460.
60.
TaylorRM, FernLA, BarberJ, et al.Longitudinal cohort study of the impact of specialist cancer services for teenagers and young adults on quality of life: Outcomes from the BRIGHTLIGHT study. BMJ Open, 2020; 10(11):e038471.
61.
SprangersMA, SchwartzCE. Integrating response shift into health-related quality of life research: A theoretical model. Soc Sci Med, 1999; 48(11):1507–1515.
62.
RapkinBD, SchwartzCE. Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health Quality Life Outcomes, 2004; 2:1–12.
63.
SchwartzCE, SprangersMAG. Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med, 1999; 48(11):1531–1548.
64.
HaukenMA, LarsenTMB, HolsenI. “Back on Track”: A longitudinal mixed methods study on the rehabilitation of young adult cancer survivors. J Mixed Methods Res, 2019; 13(3):339–360.
65.
MariboT, IbsenC, ThuesenJ, et al.Hvidbog om rehabilitering [White Book on Rehabiltation].Rehabiliteringsforum Danmark: Aarhus; 2022.
66.
GeueK, SenderA, SchmidtR, et al.Gender-specific quality of life after cancer in young adulthood: A comparison with the general population. Qual Life Res, 2014; 23(4):1377–1386.
67.
PfadenhauerLM, GerhardusA, MozygembaK, et al.Making sense of complexity in context and implementation: The Context and Implementation of Complex Interventions (CICI) framework. Implement Sci, 2017; 12(1):21.
