A Review of Factors Contributing to the Shortage of Palliative Care Service for Adolescent and Young Adult Oncology Patients

Adolescent and young adult oncology (patients aged 15–39 years old) is an emerging group of patients that are recognized to have distinctive qualities concerning their cancer treatment, including intensified psychosocial needs compared to their adult and child counterparts (Bleyer, 2012). The quality of life for adolescent and young adults during and after cancer treatment is disproportionally worse than what is reported by adults and children and the incidence of cancer in this population is steadily growing (Bleyer, 2011, 2012; Pritchard, Cuvelier, Harlos, & Barr, 2011; Rosenberg & Wolfe, 2013; Siegel, Naishadham, & Jemal, 2013; Wein, Pery, & Zer, 2011). Palliative medicine refers to an interventional service that specifically targets improving a patient’s quality of life throughout their care and has been specifically tailored in the oncology treatment guidelines and care principles for adults and children. The healthcare system, however, has been slow to notice how palliative medicine could positively contribute to adolescent and young adult oncology care. Consequently it has been under considered for this patient group. It has yet to be studied in depth as a viable and beneficial service to this cohort. Using a comprehensive literature review, this dissertation explores current shortages in palliative medicine among the adolescent and young adult oncology population. Employing multiple search modalities for key terms of the research topic resulted in 28,832 article returns. Titles and abstracts were reviewed and 36 articles were used in the literature review along with seven grey literature publications. Aspects of palliative care delivery and quality were investigated. Several themes emerged from the literature as well as specific clinical considerations for working with this patient group. Systemic barriers influencing the identified shortages were also examined. Recommendations for remediation are discussed where applicable, as well as the current state of addressing or not addressing each shortage. The role of psychologists in palliative medicine and care of adolescent and young adult oncology patients is also discussed. By illuminating the shortages in palliative care service to the adolescent and young adult oncology population, this dissertation can act as a stimulus to guide the creation of treatment guidelines or assist in future service and program development having proactively identified areas in need of attention. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/et