Background: Cancer is an unexpected diagnosis in young adulthood, which can disrupt normal developmental milestones. Testicular cancer and Hodgkin lymphoma typically affect young adults, however relatively few studies have explored the psychosocial impact of these cancers. This thesis aimed to explore the process of psychosocial adjustment to these cancers in young adulthood in order to inform intervention development and service provision.
Methods: Patients who had completed treatment for testicular cancer or Hodgkin lymphoma were recruited from three hospitals in England through invitation from the clinical team. Qualitative semi-structured interviews were conducted over two time points in the year following treatment completion with 28 participants (18 testicular cancer and 10 Hodgkin lymphoma survivors), aged between 21-44 years old (22 male and 6 female). In total, 48 interviews were conducted. Data were analysed using grounded theory.
Findings: Positive psychosocial adjustment involved the overall process of dismantling the current and future threats of cancer, which entailed two transitions of gaining a sense of perspective over the threats of cancer and striving to get on with life and restore normality. The first transition was achieved by the processes of weighing up the significance of cancer, taking an active approach to overcoming the threats and positively reframing the threats of cancer. The second transition was achieved through the processes of accepting and normalising the threats of cancer, re-establishing a sense of security and letting go of fears, and preserving and enhancing a normal self. Negative psychosocial adjustment entailed two transitions; losing a sense of perspective over the threats of cancer (Transition 1) and struggling to achieve a sense of normality after cancer (Transition 2). The first transition included the processes of holding negative illness perceptions, taking a generalised view of cancer and adopting a stoical and silent approach. The second transition included the processes of struggling to accept the threats, losing a sense of security after treatment completion and ruminating on fears.
Conclusions: This theory highlights both positive and negative adjustment trajectories in young adult cancer survivors. This has implications for the development of psychosocial interventions aimed at supporting negatively adjusted patients. In particular, health professionals could promote adjustment through addressing negative illness beliefs, preparing patients for the transition to survivorship and facilitating peer support. Young adults exhibited preferences for informal psychosocial support, which has implications for the development of one-to-one peer mentoring interventions, as well as other interventions that may promote self-management
