Cancer Survivorship and Disparities Among AYAs

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I am an early-stage investigator in the Department of Health Disparities Research at The University of Texas MD Anderson Cancer Center. I have been trained in the fields of psychology and health disparities research, particularly for cancer survivorship and prevention. Originally from Korea, I began my career in cancer survivorship research at the National Cancer Center in 2010. After obtaining my master’s degree in Clinical and Counseling Psychology, I had a Clinical Psychology Internship at the National Cancer Center. There, I had extensive clinical experience with cancer survivors and realized the importance of their quality of life. For example, I conducted psychological assessments of pediatric patients to follow their level of functioning after proton therapy, of young to middle-aged patients to evaluate their adjustment to cancer, and of elderly patients to evaluate their cognitive functioning pre- and post-cancer treatment. Under the supervision of a licensed clinical psychologist, I also led or co-led group-based psychotherapy for stress management, insomnia, and anxiety to reduce patients’ symptom burden and improve their quality of life.

My passion for cancer survivorship research led me to come to the United States to obtain a doctoral degree. During my graduate studies at the University of Connecticut (UConn), I continued cancer survivorship research. There, for the first time, I learned about the unique issues that adolescent and young adult (AYA) cancer survivors experience. Under the mentorship of Dr. Crystal Park, who was among the few scientists pioneering work on AYA cancer survivorship, I participated in her project, developing one of the first quality-of-life measures specific to AYA cancer survivors—the Late Adolescent and Young Adult Survivorship-Related Quality of Life measure (LAYA-SRQL)—early in my graduate research. Through this research project, ten important domains of quality of life specifically for AYA cancer survivors were found, which included (1) existential/spirituality, (2) coping, (3) relationship, (4) dependence, (5) vitality, (6) healthcare, (7) education/career, (8) fertility, (9) intimacy/sexuality, and (10) cognition/memory. With Dr. Park, I continued working on identifying psychological factors that may influence AYA cancer survivors’ quality of life, such as cancer-related identities, spirituality, and fear of cancer recurrence.

In 2016, I received my doctoral degree in Personality Psychology from UConn. After that, I went to City of Hope National Medical Center, a National Cancer Institute-designated comprehensive cancer center in California, for postdoctoral training in population science. During this training I became increasingly passionate about health disparities research, which focuses on groups of individuals who are more likely to be diagnosed with cancer, suffer from cancer-related health complications, and die of cancer. Thus, I pursued my second postdoctoral training in cancer disparities research at MD Anderson Cancer Center.

My postdoctoral training at MD Anderson is particularly meaningful because this was the time that I realized that AYA cancer survivors is a group experiencing health disparities. Specifically, I learned the existence of a term, the “AYA gap”, which reflects that advances in survival rates among AYA cancer patients are less than those among pediatric and older adult cancer patients. And the National Cancer Institute has recognized this AYA gap as a health disparity that needs special attention! Simultaneously, I realized that AYA cancer survivors report suboptimal health-related behaviors, but they remain an understudied survivor group. For example, AYA cancer survivors report higher rates of unhealthy eating and smoking than their peers without cancer. Also, many AYA survivors report at least some alcohol use, no leisure-time physical activity, and sleep issues (such as trouble falling or staying asleep). Because there is strong evidence showing that engaging in health behaviors (such as physical activity, low sedentary behavior, healthy eating, no smoking, no alcohol use, quality sleep) is essential for improving cancer survivors’ health, it is urgent for us to develop a program that improves AYA cancer survivors’ health!

To develop an age-specific and effective program to improve AYA cancer survivors’ health and quality of life, I felt it was necessary to include their family caregivers because of the interrelatedness between survivors and caregivers. For example, stress experienced by a cancer survivor or caregiver can affect the quality of life of the other person in the relationship as it can spill over into the relationship. So, I began expanding my AYA survivorship research by targeting both cancer survivors and their family caregivers. Particularly, my team has begun a new study that aims at examining changes in stress, health-related behaviors, and quality of life among young adult (25-39 years) cancer survivors and their significant others/partners. This 4-year study is being supported by the Department of Defense. We hope that the results of this study will direct us to develop a psychosocial or behavioral program that effectively improves young adult cancer survivors’ health and quality of life.

It is almost impossible for me to imagine the lives of young adults and their partners coping with cancer because young adulthood is an important time when many developmental changes occur (such as becoming parents and getting married, which some of the young adult cancer survivors participating in our study were experiencing). Despite the challenges, I believe many AYA cancer survivors are strong and resilient. They are not giving up to the stress and social impacts related to stupid cancers but rather are carrying on with their lives. So, I am grateful for the opportunities to work with this survivor group, who is inspirational, and I will continue working on reducing health disparities among AYA cancer survivors. I appreciate all the cancer survivors and their family caregivers who are willing to participate in research studies and devote their time and efforts to advance the science in cancer survivorship and cancer disparities research.

By: Dalnim Cho