Background Because of the global spread of coronavirus disease 2019 (COVID‐19), oncology departments across the world have rapidly adapted their cancer care protocols to balance the risk of delaying cancer treatments and the risk of COVID‐19 exposure. COVID‐19 and associated changes may have an impact on the psychosocial functioning of patients with cancer and survivors. This study was designed to determine the impact of the COVID‐19 pandemic on young people living with and beyond cancer. Methods In this cross‐sectional study, 177 individuals, aged 18 to 39 years, were surveyed about the impact of COVID‐19 on their cancer care and psychological well‐being. Participants also reported their information needs with respect to COVID‐19. Responses were summarized with a content analysis approach. Results This was the first study to examine the psychological functioning of young patients and survivors during the first weeks of the COVID‐19 pandemic. A third of the respondents reported increased levels of psychological distress, and as many as 60% reported feeling more anxious than they did before COVID‐19. More than half also wanted more information tailored to them as young patients with cancer. Conclusions The COVID‐19 pandemic is rapidly evolving and changing the landscape of cancer care. Young people living with cancer are a unique population and might be more vulnerable during this time in comparison with their healthy peers. There is a need to screen for psychological distress and attend to young people whose cancer care has been delayed. As the lockdown begins to ease, the guidelines about cancer care should be updated according to this population's needs.

Background: Adolescent cancer survivors are a particularly vulnerable group of young patients. Compared with healthy peers, adolescent survivors face more psychosocial difficulties and are at increased risk of developing psychiatric disorders. Aims:We aimed to establish prevalence rates and predictors of psychiatric disorders in young cancer survivors and discuss areas for targeted interventions. Method:We systematically reviewed four major online databases: Embase, PsychINFO, Scopus, and Medline for quantitative studies evaluating mental health in adolescent cancer survivors. We used a narrative synthesis approach.Results: Nineteen studies met our inclusion criteria. Across the sample, up to 34% met criteria for post-traumatic stress disorder (PTSD), 13% for clinical depression, and 8% for anxiety. Maladaptive coping, illness relapse, higher number of late effects, brain tumor diagnosis, and poor family functioning and parental distress were associated with higher psychological distress. Conclusions:A significant subset of adolescent survivors reports PTSD, anxiety, and depression symptoms. Individuals who present with more vulnerabilities and higher risk indices should be routinely assessed in order to reduce the psychological, social, and economic burden associated with poor mental health in this population.Early prevention strategies should target maladaptive coping mechanisms and promote healthy peer relationships and family functioning.

BackgroundRandomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions.ObjectiveTo develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates.MethodsWe describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures.ResultsNo patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD.ConclusionsInternet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD.Highlights of the articleiCT-PTSD was acceptable to patients and associated with very large improvements on PTSD outcome and process measures.iCT-PTSD required substantially less therapist time than CT-PTSD.iCT-PTSD may be associated with changes in employment status.Randomised controlled trials are required to systematically evaluate the acceptability and efficacy of iCT-PTSD.

Background: Working alliance has been shown to predict outcome of psychological treatments in multiple studies. Conversely, changes in outcome scores have also been found to predict working alliance ratings.Objective: To assess the temporal relationships between working alliance and outcome in 230 patients receiving trauma-focused cognitive behavioral treatment for posttraumatic stress disorder (PTSD).Methods: Ratings of working alliance were made by both the patient and therapist after sessions 1, 3, and 5 of a course of Cognitive Therapy for PTSD (CT-PTSD). Autoregressive, cross-lagged panel models were used to examine whether working alliance predicted PTSD symptom severity at the next assessment point and vice versa. Linear regressions tested the relationship between alliance and treatment outcome.Results: Both patients' and therapists' working alliance ratings after session 1 predicted PTSD symptom scores at the end of treatment, controlling for baseline scores. At each assessment point, higher therapist working alliance was associated with lower PTSD symptoms. Crossed-lagged associations were found for therapist-rated alliance, but not for patient-rated alliance: higher therapists' alliance ratings predicted lower PTSD symptom scores at the next assessment point. Similarly, lower PTSD symptoms predicted higher therapist working alliance ratings at the next assessment point. Ruminative thinking was negatively related to therapists' alliance ratings.Conclusions: Working alliance at the start of treatment predicted treatment outcome in patients receiving CT-PTSD and may be an important factor in setting the necessary conditions for effective treatment. For therapists, there was a reciprocal relationship between working alliance and PTSD symptom change in their patients during treatment, suggesting that their alliance ratings predicted symptom change, but were also influenced by patients' symptom change.