Scientific Objective and Rationale for the Proposed Project: Young adulthood is a unique period when various life transitions occur. This is often the period when people typically leave their home and parents, gain additional education or employment, become more independent in decision making, and form their own family. Cancer diagnosis and treatment during this critical period may cause significant delays and disruptions in successful life transitions, making cancer diagnosis and treatment a life-threatening, stressful event to young adults. Many young adult cancer survivors also have lingering psychological symptoms (depression, anxiety) and low quality of life, but existing interventions developed for young adult survivors did not much succeeded in improving their quality of life and psychological symptoms.

To better understand and ultimately enhance young adult survivors’ quality of life, how they cope with cancer-specific as well as day-to-day stress as they transition to survivorship needs to be known. Studies conducted among young adults who do not have cancer showed that health behaviors (alcohol use, smoking, exercise, eating behaviors) are often used as coping mechanisms to reduce stress. However, the effects of stress on health behaviors remain unknown among young adult survivors, even though they report poor health behavior profiles (high smoking rates, alcohol use, and unhealthy eating and no exercise). Furthermore, despite the fact that stress impacts relationships (for example, partners’ stress influences survivors’ quality of life), to date, studies examining whether and how young adult survivors and their partners influence each other’s stress, health behaviors, and quality of life do not exist.

Given the need to enhance health outcomes for young adult cancer survivors and failure of current interventions, we argue that in-depth investigation into dynamic changes in stress, health behaviors, and quality of life in young couples coping with cancer is urgently needed. Accordingly, the purpose of the proposed study is to identify relations between stress, health behaviors (as coping strategies to reduce stress), and quality of life in the transition from active treatment to survivorship for young adult survivors and their partners to eventually develop a program that effectively enhances their quality of life. The long-term goal of this study is to widely disseminate the developed program to support young adults and their family members affected by cancer in the US. To achieve this goal, a total of 300 participants who are young adults (25-39 years at time of cancer diagnosis) under cancer treatment and their cohabitating spouses/romantic partners (either married or not) will be enrolled and studied. This is the first study in which young adult survivors and their partners will be asked to complete a daily survey (for 7 days) about stress, health behaviors, and quality of life for 9 times over a 2-year period, each 3 months apart. Results of this proposed study may eventually support the young adults and their partners (and potentially other family caregivers) by helping them with stress management skills to effectively reduce both major (cancer-related) and minor (everyday hassles) stress.

Relevance to Military Health: Understanding interactions between young adult survivors and their partners and ultimately developing an intervention such as a stress management program that improves both young adult survivors’ and partners’ quality of life is highly relevant to military personnel, including those who are young adults affected by cancer or those whose significant others or relatives are affected by cancer; veterans whose young adult children are diagnosed with cancer is yet another example. The future provision of the developed intervention to young adult survivors and their partners will likely help active duty service members return to full duty more quickly, and also improve quality of life for military personnel and their family members.

Principal Investigator’s (PI’s) Career Goals in Cancer Research: The study PI’s career goal is to become an independent investigator who conducts high-impact cancer research to reduce, and eventually eliminate, disparities in cancer. The PI’s research focuses on minorities and other underserved and understudied populations, who are disproportionately affected by cancer. Because young adult cancer patients and survivors are one such population1 and the Fiscal Year 2020 Peer Reviewed Cancer Research Program (PRCRP) explicitly includes them as a topic area (“pediatric, adolescent and young adult cancers”), the study PI’s career will be greatly benefitted from the PRCRP Scholar Award. Quality and in-depth mentoring from the study PI’s career guides, who have exceptional track records in cancer research, and collaborations with diverse scientists in cancer research through interactions with the Virtual Cancer Center Directors, and fellow scholars will spur new ideas that may effectively improve quality of life of young adults and their partners (family members) affected by cancer.