Study Helps Teens Cope with Stress of Cancer, Diabetes

The teen years can be difficult– you’re fighting for your independence but still trying to develop an identity. And your 20s come with their own obstacles, like going to college, starting a career and living on your own. Can you imagine facing those developmental milestones while injecting yourself with insulin or enduring chemotherapy?

Dr. Abby Rosenberg, medical leader for Seattle Children’s Hospital’s Adolescent and Young Adult Cancer program and researcher in Seattle Children’s Research Institute’s Center for Clinical and Translational Research, and Dr. Joyce Yi-Frazier, research health psychologist at Seattle Children’s Research Institute, have seen teens with cancer and type 1 diabetes struggle physically and psychosocially. Adolescents and young adults with cancer are less likely to achieve social milestones like college, marriage, and employment and more likely to suffer from anxiety and post-traumatic stress. Likewise, teens with type 1 diabetes struggle to control their blood sugar levels and are more likely to be depressed.

“The teen and young adult years are a critical time of transition for anyone,” Rosenberg said. “When you add a serious illness to the mix, you are asking patients to do extraordinarily hard things. We want to help them integrate the experience into their identity so they are not only surviving, but thriving.”

An intervention model

To help patients, Rosenberg and Yi-Frazier worked together on the Promoting Resilience in Stress Management (PRISM) study. PRISM is an intervention model designed to teach patients resilience – the ability to maintain psychological and physical well-being in the face of stress – to buffer the impact of serious illness.

The study included 24 patients, ages 12 to 25, who had been diagnosed with cancer or type 1 diabetes. Participants worked with trained counselors to learn four primary skills to improve their personal resilience and cope with the challenges of their illness: stress-management; goal-setting; cognitive restructuring (turning a negative into a positive) and benefit finding (extracting meaning from adversity).

“These skills are developed throughout life, but they are less likely to be strong at such a young age,” Rosenberg said. “We want these patients to grow up to be the adults they were supposed to be and to move on in their live with a new sense of meaning and purpose.”

Qualitative feedback from the participants was universally positive.

“Patients found PRISM helpful and said it should become a standard part of care soon after diagnosis,” Yi-Frazier said. “Many said they wished they’d been taught these skills earlier in their treatment.”

Helping patients thrive

While it is difficult to prove that coping skills have a direct impact on cancer survival rates, Yi-Frazier published a study in 2013 demonstrating that resilience is likely to reduce stress and improve glycemic control in adolescents with type 1 diabetes.

“We hope patients will continue to use the skills taught in PRISM so they might live healthier lives,” Yi-Frazier said.

Patients who cope with stress better may also be less likely to participate in risky behaviors like drinking or smoking.

“Anecdotally, we’ve seen that patients who can handle the stress of a serious illness are more careful with the life they’ve been given,” Rosenberg said.

This summer Rosenberg and Yi-Frazier will test the efficacy of the PRISM model in a randomized trial and hope to offer a similar intervention model to parents.

“There is more to being sick than cells and biology,” Rosenberg said. “At Seattle Children’s our goal is to take care of the whole patient – physically and psychosocially.”


  • New AYA Cancer Leader Helps Teens and Young Adults Balance Life with Cancer
  • Seattle Children’s Cancer and Blood Disorders Center
  • Seattle Children’s Adolescent and Young Adult (AYA) Cancer Program
  • Seattle Children’s Endocrinology and Diabetes program
  • Center for Clinical and Translational Research