"Mind Your Total Health" for Adolescent and Young Adult Cancer Survivors: A Feasibility Trial

Background. Over 90,000 adolescents and young adults (AYA, 15-39 years old) are diagnosed with cancer annually in America, with a total of 750,000 AYA cancer survivors in 2021. AYA cancer survivors experience disproportionately higher depression than their pediatric or adult counterparts (Zebrack et al., 2016), making it essential to address depression among this population. Cognitive behavioral therapy (CBT) is the gold-standard treatment for depression (David et al., 2018) and technology-assisted CBT programs, like Beating the Blues, are effective for treating depression (Zhang et al., 2021). However, many AYAs disengage from CBT, delivered both in person and via technology, for several reasons, including access barriers, low degree of engagement, and treatment content not being cancer relevant (Zhang et al., 2021). To overcome known access and engagement barriers, this study evaluated the feasibility of a coach-supported, technology-assisted, and entertaining CBT program, Mind-Your-Total-Health (MYTH), specifically tailored for depression among AYA cancer survivors. MYTH is a cancer-specific version of its parent program, Entertain Me Well.

Methods. This feasibility trial enrolled 12 AYA cancer survivors and randomly assigned participants into treatment (coach-supported MYTH) (n=7) or active control (coach-supported Beating-the-Blues, BtB) (n=5). Both MYTH and BtB included 8 weekly treatment sessions. Depressive symptoms are the primary outcome (measured by PHQ-9), and anxiety (measured by GAD-7) is a secondary outcome. The treatment effect was evaluated using paired sample t-tests for within-group improvement and independent samples t-tests for the between-group difference.

Results. All participants assigned to MYTH completed at least 7 out of 8 sessions, suggesting strong feasibility and acceptability of MYTH. One participant dropped out of the BtB intervention with the rest of participants (4 out of 5) completing at least 5 out of 8 sessions. Participants in both groups reported no significant difference in demographi or clinical characteristics. Paired sample t-tests revealed significant improvement for participants in both groups. MYTH and BtB participants reported a statistically significant decrease in PHQ-9, mean diff=3.86, t(6)=14.79, p < 0.001, and mean diff=2.45, t(4)=3.86, p = 0.018, respectively. Interestingly, MYTH participants reported a significant reduction in GAD-7, mean diff=2.57, t(6)=8.65, p<0.001, but the reduction was not significant among BtB participants, mean diff=1.65, t(4)=2.62, p=0.059. Independent samples t-test revealed MYTH participants reported significantly lower post-treatment PHQ-9 scores than BtB participants, mean diff=1.464, p=0.033. This suggests MYTH outperformed BtB in reducing AYA cancer survivors’ depression. The between-group difference in post-treatment GAD-7 scores was not statistically significant.

Conclusions and Implications. This study evaluated a technology-assisted, entertaining CBT program for depression, specifically tailored for young adult cancer survivors. Findings suggest MYTH is feasible and acceptable to AYA cancer survivors. Further, within-group pre- and post-score analysis revealed that MYTH significantly reduced depression among AYA cancer survivors. Most importantly, MYTH reported greater improvement than BtB – an evidence-supported depression treatment program. Findings support MYTH as a promising depression treatment for AYA cancer survivors who experience substantial barriers to care. Future studies of MYTH effectiveness are warranted, as are studies evaluating MYTH implementation by oncology social workers supporting younger cancer patients with depression and anxiety.