Examining key sociodemographic characteristics of adolescents and young adults with advanced cancer: A secondary analysis of the Promoting Resilience in Stress Management for Advanced Cancer (PRISM-AC) randomized clinical trial.

Abstract

280 Background: The "Promoting Resilience in Stress Management" for Advanced Cancer (PRISM-AC) intervention is a skills-based resilience coaching program with embedded aspects of advance care planning, and demonstrated efficacy in adolescents and young adults (AYAs) with AC. Our goal was to examine whether response to PRISM-AC differed across key sociodemographic characteristics. Methods: Using data from the multisite randomized trial of PRISM-AC vs Usual Care among English- and Spanish-speaking AYAs aged 12-24 years and diagnosed with AC within 2 weeks before enrollment, we examined patient-reported outcomes (PRO) of quality of life (QOL), anxiety, depression, and resilience at baseline and 3-months post-enrollment. PRISM participants were stratified by subgroups: male/female, White/Hispanic or Non-Hispanic persons of color (POC), English/Spanish, private/public insurance, and completion (or not) of the advance care planning session. For each subgroup, we fit a linear regression model with the 3-month PRO as the outcome and baseline PRO and the subgroup variables as covariates. Results: 195 AYAs (96 UC, 99 PRISM) were enrolled and randomized. The 99 PRISM AYAs were mean = 16.5 ± 3.8 years, 56.6% male, mostly White (61.1%) non-Hispanic (57.3%). 56.6% completed the advanced care planning session. In linear regression models adjusting for baseline QOL, Hispanic or Non-Hispanic POC participants scored higher on 3-month QOL compared to Non-Hispanic White AYAs (Table). Spanish-speaking AYAs also scored higher than English-speaking AYAs, though the numbers were small. Differences in 3-month QOL by sex, insurance type, and completion of the optional advance care planning session were not statistically significant (Table). Regression analyses for the other PROs (anxiety, depression, resilience) were not significant. Conclusions: Early findings suggest that the “Promoting Resilience in Stress Management” intervention was particularly impactful on QOL for Hispanic or Non-Hispanic POC AYAs. Clinical trial information: NCT03668223 . Adjusted difference in month 3 PedsQL by subgroup. Subgroup Comparison Estimate 95% CI P-value Race/Ethnicity Hispanic or Non-Hispanic POC vs. Non-Hispanic White 8.9 (2.5, 15.3) 0.007 Gender Male -1.8 (-8.4, 4.8) 0.585 Language Spanish vs. English 10.9 (0.4, 21.3) 0.042 Completion of Optional Advanced Care Planning Session No vs. Yes 1.2 (-5.7, 8.1) 0.737 Insurance Private vs. Medicaid/Public -1.7 (-8.3, 4.8) 0.597 Each row represents a separate linear regression model: PedsQL (Month 3) ~ PedsQL (Month 0) + Subgroup. The estimate reflects the adjusted mean difference in month 3 PedsQL for the comparison group relative to the reference group, holding baseline PedsQL constant.