Translating COSA Psychosocial Guidelines into Practice: Learnings from a National Workshop on Post-Acute Care for Adolescents and Young Adults with Cancer

Abstract

Adolescent and young adult (AYA) cancer survivors (i.e., people aged 15 to 25 years diagnosed and living with and beyond cancer) experience significant psychosocial challenges that intersect with their usual developmental needs and trajectories as young people in society [1]. Consequently, this results in a third of AYA cancer survivors reporting clinically significant psychosocial distress [2]. Further, AYA cancer survivors experience challenges in navigating education, employment and relationships, as well as identity formation, developing independence, and maintaining family bonds [1, 3]. Together, these challenges underscore the requirement of age-appropriate psychosocial care for AYA cancer survivors across each stage of the cancer continuum [4].

One stage of the cancer continuum that poses unique psychosocial challenges, and which is often neglected, is the post-acute period (0 to 5 years post-treatment completion) [5], which precedes long-term survivorship (≥5 years post-treatment completion). The post-acute period marks a major shift for AYAs, their families, and healthcare teams, from intensive medical treatment to a stronger focus on quality of life, physical recovery and development, and psychosocial well-being, both now and in the long term [6]. During this stage, the priority is to prepare the young person for post-treatment life by ensuring that necessary supports are in place, including best-practice psychosocial support to effectively address common survivorship challenges that arise during this period. Approximately 90% of AYA cancer survivors in the post-acute period report experiencing significant emotional concerns [7], with 80% reporting unmet psychosocial needs [1, 8]. Psychosocial challenges commonly reported include anxiety, depression, and fear of recurrence, in addition to developmental challenges, including autonomy and fertility preservation [1, 8]. Commonly reported psychosocial unmet needs include support related to education, employment, financial stress, and navigating relationships [1, 7-9].

Healthcare professionals of all disciplines working with AYA cancer survivors require guidance on best-practice psychosocial wellbeing screening, assessment, and care planning tailored to the post-acute period. However, this has been largely neglected. In Australia, this gap is particularly relevant given the availability of nationally coordinated, developmentally informed AYA cancer care services, including through the Australian Youth Cancer Service (YCS), which was established to deliver age‑appropriate, multidisciplinary care across jurisdictions [10]. These services explicitly identify psychosocial care as a core component of quality AYA cancer services; however, understanding and applying best-practice management of AYA cancer survivors has been challenging due to the lack of contemporary guidelines [11, 12].

In 2012, the Clinical Oncology Society of Australia (COSA) released guidelines for healthcare professionals on the psychosocial care of AYAs with cancer [13], under the national YCS program funded by the Australian Government. This document included critical guidance for healthcare professionals in Australia working with AYA cancer survivors across domains such as screening, assessment, interventions, and supportive care strategies along the cancer trajectory. However, since then, the evidence-base for AYA psychosocial oncology has grown significantly [14, 15], and the 2012 guidelines did not include a specific section providing tailored guidance to the psychosocial management of AYA cancer survivors during the post-acute period. In 2025, COSA released updated and expanded Guidelines for the Psychosocial Management of AYAs Diagnosed with Cancer [13], which included a specific ‘Recommendations for Post-Acute Psychosocial Care’ section.

The Post-Acute Psychosocial Care section of the 2025 COSA Guidelines operationalizes this transitional phase of survivorship by translating its distinctive clinical and psychosocial demands into actionable guidance for practice. Unlike long‑term survivorship, which is typically oriented toward stable late‑effects monitoring and health promotion, the post‑acute period is characterized by ongoing medical surveillance, residual or resolving treatment‑related toxicities, and uncertainty regarding recovery trajectories [16]. During this time, AYAs may continue to experience symptoms such as fatigue, cognitive and functional changes, and altered appearance, while simultaneously adjusting to reduced intensity of oncology contact and increasing expectations around independence and role resumption (such as returning to education and/or work) [5-7]. The Post-Acute Psychosocial Care section of the COSA Guidelines includes six separate recommendations for best-practice care across assessment, data-informed care, collaborative care, communication, transition, survivorship care planning, and primary care integration (see Table 1) [13]. Each recommendation is graded in the strength of its underpinning evidence. Recommendations were graded as “Strong” if the evidence was from at least one guideline or higher-level review (systematic, meta-analysis, integrative) or graded as “Weak” if the evidence was from a different type of review. The recommendations are grounded in the principle of tailored and person-centered multidisciplinary care co-developed with consumers, and informed by strategic screening and assessment, and proactive care plans.

The Post-Acute Psychosocial Care section of the COSA Guidelines provides a critically needed resource to guide care. However, despite substantial investment in evidence-based guideline development, there has historically been a persistent translation gap of guidelines to routine clinical care. Systematic reviews in cancer care demonstrate that the existence of guidelines alone rarely leads to sustained changes in care or consumer outcomes without targeted dissemination and implementation strategies [17, 18]. In psychosocial oncology, this gap is particularly well documented across age groups. Despite international standards and guidelines, uptake into routine practice is inconsistent, constrained by unaccounted-for service-level variation and limited implementation support [19]. Together, this body of evidence underscores the need for targeted, implementation-focused strategies that support clinician capability and uptake of the COSA Guidelines. Further, given that the provision of specific recommendations for the psychosocial management of AYA cancer survivors in the post-acute period is novel, additional targeted focus is required to facilitate clinical transition of these recommendations.

In 2025, following the release of the updated COSA Guidelines, the YCS, in collaboration with Canteen and COSA, held a Community of Practice (CoP) meeting in Adelaide, South Australia. The YCS CoP meetings bring together healthcare professionals from various disciplines working in youth cancer care to provide professional development and knowledge sharing on priority topics, and provide a platform for collaboration, multidisciplinary integration and continuous quality improvement. One of the key invited sessions was titled “Post-Acute Psychosocial Care for AYAs: An Interactive Workshop Implementing the COSA Guidelines for the Psychosocial Management of AYAs Diagnosed with Cancer”.

The goal of the workshop was to facilitate the translation of the 2025 COSA Guidelines Recommendations for Post-Acute Psychosocial Care into clinical practice nationally via interactive learning and practice. Evidence suggests that interactive group-based education is central to facilitating guideline translation into clinical practice in cancer care [18]; thus, the workshop included direct content drawn from the post-acute section of the COSA Guidelines, as well as group-based case-study activities. The activities included three mock cases of an AYA cancer survivor who progresses through the post-acute period and experiences psychosocial challenges. The cases were developed through an interactive and collaborative process, including authors DH, NHH, JH, USD, and key leaders of Canteen and YCS (spanning disciplines of Clinical Psychology, Neuropsychology, Exercise Science, Health Promotion, and Speech Therapy). The cases developed were informed by both clinical experience and the literature. While the cases included basic clinical oncology information, extensive tumor and treatment details were omitted to facilitate practicality and a focus on psychosocial considerations.

The workshop was facilitated by experienced AYA psychosocial clinician-researchers (JF, USD) and academics (DH). Workshop participants worked together in multidisciplinary groups of 4–10 to complete the activities across a total of 12 groups. One of the three mock cases was randomly assigned to each group, and each group used their case study to complete the workshop activities. After each activity, all groups collaboratively discussed their actions and key considerations when implementing the COSA Guidelines, guided by the workshop facilitators. An outline of the workshop session is provided in Figure 1. The first activity (i.e., transition from acute to post-acute care) was the collaborative completion of a partially filled-in Transition Rubric [20], informed by part one of the case study and the completed sections of the Transition Rubric. The second activity (i.e., transition to early survivorship) was the collaborative completion of the YCS/Canteen AYA Oncology Psychosocial Survivorship Care Plan, informed by part two of the case study and a mock-completed YCS/Canteen AYA Oncology Psychosocial Survivorship Screening Tool [21].

The 2025 COSA Guidelines for the Psychosocial Management of AYAs Diagnosed with Cancer provide critical information and key recommendations to support best-practice care. The addition of a specific post-acute section, including tailored recommendations, provides significant advancement aligned with Australia's nationally coordinated approach to AYA cancer care, which may also inform international standards. Translation and implementation of the new guidelines into clinical practice are vital. The interactive workshop developed to accompany the post-acute section offers a pragmatic approach to supporting the uptake of multidisciplinary guidelines within Australian services, while also providing a resource that may be adapted internationally to strengthen post-treatment psychosocial survivorship care for AYAs.

D.H. and N.H.H. are members of the COSA Survivorship Group Executive Committee. N.H.H. is Chair of the COSA Survivorship Group. U.S.D. was Chair of the 2025 COSA Guidelines for the Psychosocial Management of AYAs Diagnosed with Cancer. D.H., J.F., and S.G. were Working Group members for the 2025 COSA Guidelines. H.G. is the COSA Project Manager and postdoctoral research fellow for the 2025 COSA Guidelines, while R.H. was the postdoctoral research officer for the 2025 COSA Guidelines. N.H.H. is Co-Editor-in-Chief, and D.H. is Associate Editor for the Asia-Pacific Journal of Clinical Oncology.