Statistics for childhood cancer demonstrate greatly improved survival rates over the last twenty years in the United States. Depending on the type of cancer, 58-88% of children and adolescents will be long-term, disease free survivors. While such statistics are encouraging, the nature and course of many cancers has changed from an inevitably fatal illness to a chronic illness that continues to carry the potential to threaten life. The American Cancer Society had identified adolescent cancer care, including psychosocial care, as a research priority. Yet, surprisingly few data-based studies have been reported on psychosocial adjustment of adolescents with cancer (AWC). In addition, systematically planned psychosocial intervention studies with AWC are rare, even though such interventions, tested over the last 2 decades in adults with cancer, show promising results. With over 200,000 childhood cancer survivors and the numbers projected to be 1 in 250 by the year 2000, it is imperative that adjustment issues for adolescents with cancer be addressed. The purposes of this study are to: 1) examine, longitudinally, the nature and patterns of change in resilience and quality of life through analysis of the Adolescent Resilience Model (ARM) in adolescents with cancer; and, 2) evaluate the extent to which patterns of resilience and quality of life change as a result of a family and adolescent network (FAN) intervention aimed at enhancing resilience and quality of life through individual, family and social protective factors in the ARM. The study design contains two components. To answer questions about relationships and causality among individual, family and social protective factors, illness-related and individual risk factors, and resilience and quality of life among adolescents with cancer, 11-19 year of age, a prospective longitudinal descriptive design will be used. The adolescents will be followed from diagnosis through the first of living with cancer. In the last 2 1/2 years of the project, after refinement and pilot work is done on the FAN intervention, a longitudinal experimental design w ill be implemented to evaluate changes that occur in the factors in the ARM as a result of a Family and Adolescent Network (FAN) intervention that is targeted to enhance individual, family, and social protective factors in the model and minimize illness- related and individual risk factors. The proposed total sample size is 243. Analysis of study aims will be accomplished through: 1) growth curve analysis to evaluate initial state, rate of change and stability; 2) common factor modeling of growth curve parameters; and 3) structural modeling of change factors over time and as a result of the intervention.
