Among young adults with advanced cancer, developing a strong alliance with their oncologist was associated with greater perceived social support, a greater willingness to adhere to treatment, and greater adherence to oral medication, according to results of a study published in the Journal of Clinical Oncology. “These results indicate that the role of the oncologist extends beyond the prescription of medication and includes patients’ perception of social support, psychological well-being, and attitudes toward and actual behaviors regarding treatment adherence,” the authors concluded.
The 95 patients participating in the study were between ages 20 and 40, with a mean age of 33.4 years. Most were white (86.3%) and female (68.4%). More than half the sample was married (56.8%), more than one-third had dependent children (40.0%). One-third of the patients had breast cancer (33.7%), and other diagnoses included brain tumors, leukemia/lymphoma, soft-tissue cancers, and colon cancer.
All patients had advanced disease at the time they were interviewed for the study. The interviews included measures of psychosocial well-being, willingness to adhere to treatment, and treatment adherence. The Human Connection scale was used to measure the extent to which patients feel a sense of mutual understanding, caring, and trust with their oncologists. The scale has been validated in older patients with advanced cancer, although the therapeutic alliance between young adults and their oncologists “may have unique characteristics not captured in a measure developed in older samples,” the authors acknowledged.
“Alliance was significantly (P ≤ .01) and positively associated with greater perceived social support and less severe illness-related grief,” the researchers reported. “After controlling for significant confounding influences (ie, metastases, appraised support, and grief), alliance remained significantly (P ≤ .01) associated with greater willingness to adhere to treatment and greater adherence to oral medication.”
Several factors may complicate the development of strong alliances, the authors pointed out. For example, medical professionals may not be familiar with issues unique to young adults, and young adults are generally unfamiliar with the health-care system.
“Oncologists who want to foster a therapeutic alliance with their patients should strive to listen attentively to their concerns, convey respect, offer empathic support, and promote trust in working together toward shared goals of care,” the authors advised.” ■
Trevino KM, et al: J Clin Oncol 31:1683-1689, 2013.