The New New Normal: Navigating Young Adult Survivorship Amid COVID-19

Patients with cancer and their caregivers are no strangers to uncertainty. Adjusting to a “new normal” is a familiar challenge experienced by patients, post-treatment survivors, and caregivers in order to cope with change and fears of the unknown. Yet, we are hearing the term more often now as the idea of a “new normal” becomes a global concept in the face of COVID-19. Young adult cancer survivors (YA survivors: ages 20-39), a population known for having unique needs, face additional hardships in the context of a global health crisis. As the pandemic progresses and the long-term emotional effects of COVID-19 become clear, it is imperative to address the specific impact experienced by YA cancer survivors.

The New Normal

Prior to COVID-19, YA survivors may have looked forward to ending treatment because they were ready to “get back to their lives.” However, the pandemic has taught this population that doing so may look different. Now, YA survivors must adjust their expectations yet again as their “new normal” is anything but. For some, this may mean taking similar precautions as they did while they were undergoing treatment. For others, this may mean putting future plans on hold. With the introduction of additional uncertainty, YAs may experience increased feelings of anxiety, fear and isolation.¹

Physical Well-Being

While there is currently limited evidence suggesting that different precautions should be recommended for cancer survivors (wearing a mask, social distancing, hand washing, etc.)², clinicians should take additional time to address individual needs of patients and survivors as they arise.

YA survivors face the added challenge of remaining connected to their medical team in times of COVID. Regular follow-ups may be postponed or replaced with telehealth visits. While telehealth has had a positive impact on this population, it’s important to be aware of the additional barriers related to accessibility and technology. Increasing support and communication between YA survivors and their medical teams may decrease feelings of fear and anxiety regarding their survivorship and risk of COVID-19.

Emotional Well-Being

YAs have shared that the period after treatment is sometimes more difficult than the treatment itself. Navigating the transition from patient to resuming “normal life” also means coping with uncertainty and the fear of recurrence.2 Navigating the same transition during a pandemic is no easy feat. YAs are coping with all of the emotional components that accompany survivorship along with new challenges brought on by social distancing and COVID protocols/guidelines. With social distancing measures in place across the country, it is important to be aware of the negative consequences that isolation can have on those that are already at risk for emotional distress.3

YAs have reported increased difficulty managing personal relationships, including partnerships, friendships, and familial relationships. With increased feelings of isolation, YAs struggle to make their family and friends understand the importance of following COVID safety protocols (social distancing, wearing a mask, etc.). Some YAs reported that this increased sense of isolation has been triggering, feelings as if starting treatment all over again. There are increased reports of: anxiety (both general and in regards to health), low moods, feelings of loneliness, changes in cancer care, negative financial impacts and fears of contracting COVID/passing COVID to a loved one.4 While not all inclusive, these reports coincide with what we are witnessing among this population in the last several months. Recognizing and acknowledging these factors is the first step in supporting this population.

Supporting YA Survivors during COVID-19

Continuity of care. Those that have recently transitioned off treatment are at a higher risk for experiencing symptoms of anxiety related to COVID-19. Compliance for follow-up care is imperative for these YAs, as they have an increased chance of experiencing emotional distress . Creating a survivorship care plan for those making a treatment transition can help YAs feel more secure about their continuity of care. Many YAs feel that once they complete treatment, they no longer have support from their medical team. Ensure patients and survivors that while in-person visits may be limited, their medical team will be available via tele-health in the interim.

Normalize the need for support. Since YAs are already known for experiencing increased feelings of isolation during and after cancer treatment, we understand the importance of support for this population. However, with the limitations on in-person contact, support may look a little different these days. Encourage YA survivors to expand their support system, even if it means getting creative. Most in-person support groups have transitioned to secure video platforms and a wide variety of online support groups are available as well. Individual support is also available as mental health professionals across the country have made telehealth services available by phone and video.

Recognize additional barriers. While YA survivors are facing additional physical and emotional challenges due to COVID-19, it is important to recognize additional barriers as well. Many YAs have lost their jobs which may put them at risk for losing health insurance. For those that have recently completed treatment, they may have a difficult time paying for their follow-up visits or maintenance medications. Loss of employment can lead to financial strain and emotional distress. It may be helpful to gather financial, employment and legal resources for those facing similar challenges.

CancerCare Can Help

CancerCare is well-versed in YA survivorship issues and concerns. Along with individual support, live and online support groups, CancerCare offers a series of community programs specifically designed for the young adult population. To learn more, visit www.cancercare.org/youngadults.

References

1. Coping — New Normal. (n.d.). Retrieved December 01, 2020, from https://www.cancer.gov/about- cancer/coping/survivorship/new-normal

2. Verbruggen, L., Wang, Y., Armenian, S., Ehrhardt, M., Pal, H., Dalen, E., . . . Kremer, L. (2020, September 23). Guidance regarding COVID‐19 for survivors of childhood, adolescent, and young adult cancer: A statement from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Retrieved December 01, 2020, from https://onlinelibrary.wiley.com/doi/10.1002/pbc.28702

3. Košir, U., Loades, M., Wild, J., Wiedemann, M., Krajnc, A., Roškar, S., & Bowes, L. (2020, July 22). The impact of COVID‐19 on the cancer care of adolescents and young adults and their well‐ being: Results from an online survey conducted in the early stages of the pandemic. Retrieved December 01, 2020, from https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.33098

4. Nekhlyudov, L., Duijts, S., Hudson, S., Jones, J., Keogh, J., Love, B., . . . Feuerstein, M. (2020, October). Addressing the needs of cancer survivors during the COVID-19 pandemic. Retrieved December 01, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183255/