An HRQOL Proof-Of-Concept Analysis of the eHealth TOGETHER Intervention for Adolescent and Young Adult Cancer Survivors: A Brief Report

Background: Adolescent and young adult (AYA) cancer survivors ages 18–39 report elevated stress and poor health-related quality of life (HRQOL), yet few evidence-based stress management interventions exist that meet their specific needs. Our team designed TOGETHER, a 10-week eHealth group-delivered behavioral intervention designed to improve HRQOL via stress management skills training. To date, TOGETHER has been delivered to seven groups of AYAs, and its feasibility and acceptability have been well established. Aims: This proof-of-concept analysis explored TOGETHER's impact on patient-reported outcomes among AYAs. Methods: Participants were English-speaking AYAs aged 18–39 who were diagnosed with cancer while aged 15–39 and had completed curative treatment within the past five years. Patient-reported outcomes were assessed at baseline and post-intervention and included HRQOL, stress management skills self-efficacy, coping strategies, and depression and anxiety symptoms. Pre-to-post-intervention changes were assessed with paired-samples t-tests among those with complete data (n = 39) and using a series of imputation strategies. The proportion of participants achieving clinically meaningful change was computed when possible. Results: Participants (N = 51) had an average age of 29 years and were predominantly female (78%), White (69%), and non-Hispanic (80%). HRQOL significantly improved from pre-to post-intervention with small-to-moderate effect sizes (gs ranged from 0.32–0.60), and more than half of participants (51%–59%) demonstrated clinically meaningful improvement. Statistically significant improvements were found for stress management skills self-efficacy, coping, and depression symptoms, but not anxiety symptoms. Conclusions: Results provide proof-of-concept evidence that TOGETHER can meaningfully improve patient-reported outcomes among AYA survivors, supporting continued evaluation of the intervention. Trial Registration: ClinicalTrials.gov; NCT05048316, NCT05054569, NCT05597228, NCT05952492.