Young Adult Survivors United Cancer Research Registry
Conditions: Cancer, Leukemia, Sarcoma, Germ Cell Cancer, Lymphoma, Colorectal Cancer, Melanoma, Breast Cancer
Sponsor: Young Adult Survivors United

 
Research Registry Protocol Title: YASU Research Registry 
 
 
Research Registry Sponsor:   
Young Adult Survivors United (YASU) 
 
Principal Investigator: 
Principal investigator: Bethany Nugent, PhD, RN 
 
 
 
 
 
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Table of Contents: 
 
List of Abbreviations:​
3 
Introduction​
5 
Background Information and Scientific Rationale​
5 
Registry Specific Aims​
7 
Registry Design​
7 
Research Design​
7 
Registry Site(s)/Location(s) and Number of Subjects​
7 
Subject Selection​
7 
Vulnerable Populations (if applicable)​
7 
Participant Selection​
7 
Inclusion Criteria​
7 
Exclusion Criteria​
8 
Waiver of Written Documentation of Consent or Waiver of Consent​
8 
Registry Procedures​
8 
Specific Training​
8 
Recruitment of participants​
8 
Data Collection Schedule​
9 
Registry Duration​
10 
Data Management and Quality Plan​
11 
Data De-identification​
11 
Data Confidentiality, Storage, and Retention​
11 
Data Qualityhillman​
11 
Data Sharing​
12 
Registry Data Points​
12 
Statistical Analysis Plan​
13 
Potential Risks and Benefits​
13 
Potential Benefits​
13 
Potential Risks​
13 
Mitigation of Risks​
14 
Provisions to Protect the Privacy Interest of Registry Participants​
14 
 
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Early Withdrawal of Subjects​
14 
Investigator Withdrawal of Subjects​
14 
Subject Request for Withdrawal from Registry​
14 
Data Collection and Follow-up for Withdrawn Subjects​
14 
Adverse Event Reporting​
14 
Adverse Events​
14 
Ethical Considerations​
15 
Sharing of Results with Subjects​
15 
Funding Source​
15 
Subject Stipends or Payments​
15 
References​
15 
 
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List of Abbreviations: 
YASU: Young Adult Survivors United 
AYA: Adolescent and Young Adult 
YA: Young Adult 
PHQ-9: Patient Health Questionnaire-9 
GAD-7: General Anxiety Disorder-7 
MOS: Medical Outcomes Study 
COST-FACIT: Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic  
Illness Therapy 
AYA-POST: Adolescent and Young Adult Psycho-Oncology Screening Tool 
 
 
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Introduction 
 
This document is a protocol for a human research registry. This registry is to be conducted 
according to US standards of Good Clinical Practice in accordance with applicable Federal 
regulations and research policies and procedures.  
 
 
Background Information and Scientific Rationale  
 
In a 2006 landmark report, the National Cancer Institute recognized adolescents and 
young adults (AYAs) with cancer as a distinct subset of oncology patients, “distinguished by 
physiologic, developmental, and societal 
characteristics.” (National Cancer Institute & 
Livestrong Young Adult Alliance, 2006) This 
report also showed that survival rates of AYA, 
ages 15-39, had not appreciably improved since 
the 1970s, despite improvements in both younger 
and older counterparts (Figure 1). While some 
data suggest that overall survival in AYA is now 
beginning to improve (Close et al., 2019), the rate 
of cancer in AYAs has increased by nearly 30% 
since the 1970s. (Scott et al., 2020) About 90,000 
young adults (AYA) between the age of 15 and 39 
are diagnosed with cancer each year in the United 
States, accounting for about 5% of all annual 
cancer diagnoses. (American Cancer Society, 
2020)  
The AYA age range of 15-39 was chosen 
to be inclusive rather than exclusive and because 
it aligned with the lag in survival rate 
improvements compared to younger and older 
age groups. (National Cancer Institute & 
Livestrong Young Adult Alliance, 2006). Despite similarities, AYAs can vary widely in terms of 
their psychosocial development and emotional maturity– differences that may or may not 
correlate with chronological age. For instance, the psychosocial needs of a 15-year-old 
adolescent attending high school and living at home with parents differs greatly from young 
adults who may be living on their own, beginning careers, gaining financial independence, 
starting a family, raising children, or caring for aging parents.  
This recognition of different developmental stages and concerns within the AYA group 
was the impetus for Stephanie Samolovitch, MSW to found Young Adult Survivors United 
(YASU) in 2020. YASU’s mission is to support young adults (YAs), ages 18-39, with cancer. 
(Young Adult Survivors United, n.d.) Since 2020, YASU has been providing virtual support 
groups for survivors and co-survivors impacted by YA cancer. YASU also hosts regular socials, 
has a financial assistance program and provides respite opportunities. Since the group's 
 
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inception, close to 500 members have joined from Western Pennsylvania, across the US, and 
from numerous countries around the world. YASU has demonstrated the need for YA specific 
support. Young adults with cancer from many other states and countries have participated in 
YASU because there are so few resources to support these individuals. Truly, YASU is building a 
sustained community of support for those impacted with YA cancer. 
Too often, AYAs fall into “no man’s land” between pediatric and adult oncology with few 
options for AYA specific expertise and care. In research studies, AYA are often grouped together 
with pediatric or adult patients and not seen as a distinct group. This has limited our 
understanding of the unique needs and outcomes of those diagnosed with cancer as an AYA. To 
our knowledge, only two large research registries have been organized to study the AYA 
population. 
​
The Childhood Cancer Survivor Study (CCSS) follows participants diagnosed up to age 
20. The purpose of CCSS is to gain new knowledge about the long-term effects of cancer and 
therapy. As of January 2021, this study includes a cohort of 4244 AYA diagnosed between 15 
and 20. While the follow-up with these individuals is in-depth, longitudinal, and ongoing, young 
adults (YA) diagnosed with cancer after the age of 20 are not represented in this dataset. 
​
In 2007, the Adolescent & Young Adult Health Outcomes & Patient Experience Study 
(AYA HOPE) study was conducted in patients diagnosed between the ages of 15 and 39 with one 
of the following cancers: germ cell, Hodgkin lymphoma, non-Hodgkin lymphoma, acute 
lymphoblastic leukemia (ALL), or sarcoma (Ewing, osteosarcoma, or rhabdomyosarcoma). 
Altogether, AYA HOPE includes approximately 530 AYA cancer patients with follow-up 
approximately 24 months post-diagnosis. Participants were recruited from one of the following 
SEER cancer registries: Los Angeles, Seattle-Puget Sound, Iowa, Louisiana, Detroit, Northern 
California, and Greater California. This study concluded in July, 2010. AYA HOPE is an 
important study which provides a preliminary framework to describe the unique challenges of 
AYA diagnosed with cancer, (namely, financial burden, education and work, relationships and 
family planning, as well as physical and mental health), however many YA cancers were not 
represented in this dataset and only individuals from certain parts of the country were included. 
Furthermore, the study only includes one follow-up and the study is no longer gathering data.  
​
There is a lack of age-relevant support and resources as well as a gap in the knowledge of 
the needs and outcomes of YAs with cancer. YASU has a unique opportunity to add to the 
literature by surveying participants in an ongoing manner from its members in Western 
Pennsylvania, across the country, and around the world. This dataset will help to explore the 
unmet needs of YAs with cancer, determine effectiveness of programming, as well as plan for 
future programming to serve this population. In the future, we hope to be able to also make this 
dataset available to other academicians and researchers interested in improving the health and 
wellbeing of YA survivors with cancer. 
 
 
 
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Registry Specific Aims 
Through this research registry we plan to: 
1.​ Objectively measure patient-reported symptoms (depression, anxiety, distress), 
perceived social support, financial toxicity and needs in survivors of young adult 
cancer at baseline and over time. 
2.​ Determine effectiveness of YASU programming by examining its possible 
mediation on the measures of Aim 1. 
3.​ Identify patients who may be eligible for participation in future research studies. 
 
 
 
Registry Design 
Research Design  
 
This registry will prospectively collect data from young adult cancer survivors using 
electronic surveys to describe patient-reported needs and outcomes at baseline as well as 
changes over time. Please note that all information collected for this registry is 
self-reported and not confirmed. 
 
Registry Site(s)/Location(s) and Number of Subjects 
YASU website registration page: yasurvivors.org 
 
Total number of all sites: 1 
Estimated number of subjects at all sites combined: undetermined. ongoing recruitment 
will occur as members register with the organization. 
 
 
Subject Selection 
Vulnerable Populations (if applicable) 
 N/A 
 
Participant Selection 
Inclusion Criteria 
1.​ Diagnosed with cancer between the ages of 18 and 39. 
2.​ Able to speak and read English. 
 
This registry is designed to explore the specific concerns, needs, and outcomes of those 
diagnosed with cancer as YAs (ages 18-39). Potential participants will be required to 
comprehend English as some of the surveys we will administer have not been validated in other 
languages. Additionally, YASUs programming is conducted in English. Without the ability to 
comprehend English, individuals would not be able to participate in YASU programming and we 
would not be able to test for possible mediation, as listed in Aim 2. 
 
 
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Exclusion Criteria 
1.​ Inability to provide consent (such as neurological illness or mental 
incapacity) 
2.​ Has not registered as a member of YASU 
 
 
Waiver of Written Documentation of Consent or Waiver of Consent  
 
We are applying for a Waiver of Written documentation of Consent (consent will be 
obtained but signatures will not be required) as this study is minimal risk and will 
be conducted completely electronically. 
 
 
Registry Procedures 
Specific Training 
 
After IRB approval and prior to study initiation, the PI will meet with members of 
the YASU organization to explain the registry and procedures for consent and data 
collection and their roles and duties including answering any questions or concerns that 
may arise. Besides an email sent to current YASU members inquiring about their interest 
in research registry participation, the consent for new members and ongoing surveys for 
those who consent to participate will be automatically triggered and sent (using 
Salesforce) so we do not anticipate needing significant involvement from YASU 
organizational staff members for ongoing study management. 
 
Recruitment of participants 
 
YASU members who have already registered with the organization will 
receive an email providing an overview of the registry at a time point after IRB 
approval for the registry has been secured. No previous data they provided will be 
used in the research registry. Only information that they provide in the future will 
be used. Any new members registering with YASU will be provided with this 
information at the time of registering with the organization  If the member would 
like to participate in the research registry, they may access a webpage (data 
security measures are discussed later in the protocol) which will provide an 
overview of the purpose of the study and expectations. Potential participants will 
be informed that their participation in the registry is voluntary and will not in any 
way change their relationship with the YASU organization. Potential participants 
will be given as much time as they need to review the study description and will 
be provided with the PI’s and/or a YASU staff member's email to answer any 
questions they may have before providing consent via the webpage. Additionally, 
for any current members, we will offer a virtual session to describe the study and 
 
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provide a forum for questions, should they so choose. Potential participants will 
not be required to attend the virtual session; they may also choose to email the PI 
or YASU staff members with questions, if they prefer. 
 
Participants will be offered two levels of consent. They will be asked to enter the registry 
for research purposes. They will also choose to opt-in or opt-out of consenting to future 
contact [for further follow-up or for invitation to participate in additional research 
studies]. “Opting-in” to future contact will allow us to use the contact information they 
provided to YASU to facilitate future contact (e.g. name, email address, phone numbers, 
mailing address) for researchers who have received approval from YASU. Participants 
will provide consent electronically by certifying they have read the information sheet and 
either agree or do NOT agree to participate in the registry. They will also either choose to 
agree to future contact for research or NOT agree to future contact for research. 
 
 
Data Collection Schedule 
Cancer survivors will be asked for consent at the time of registration with YASU or (in 
the case of those who have already registered) with an email sent to describe study and 
providing an opportunity to give consent and participate in the registry. Baseline and 
annual follow-up data will be collected according to the table below. In addition, 
participation in organizational sponsored programs (e.g., socials, support groups, 
financial assistance) will be recorded and included in the research registry. 
 
 
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Instrument 
 
Assessment Time Points 
# Items 
(Approx. time) 
Baseline 
6 mos., 
then 
Yearly 
Demographics 
     Race 
     Gender 
     DOB 
     Address 
 
 
 
✔ 
✔ 
✔ 
✔ 
 
Disease and treatment 
information 
     Age at Diagnosis 
     Type of cancer 
     Stage 
     Treatment 
 
 
 
 
✔ 
✔ 
✔ 
✔ 
 
Change in disease or 
treatment 
Compared to a year ago, is 
your health: better, about 
the same, or worse [If 
better or worse, then allow 
free text to explain why] 
 
 
✔ 
Depression 
PHQ-9 
9 
(2 min) 
✔ 
✔ 
Anxiety 
GAD-7 
7 
(1-2 min) 
✔ 
✔ 
Distress 
Distress Thermometer 
(included in AYA-POST) 
1 
(30 sec) 
✔ 
✔ 
Needs Assessment 
AYA Psycho-Oncology 
Screening Tool 
(AYA-POST) 
50 
(5 min) 
✔ 
 
Financial Toxicity 
COST – FACIT (Ver 2) 
12 
(3 min) 
✔ 
✔ 
Social support survey 
instrument 
MOS Social Support 
Survey Instrument 
19 
(5 min) 
✔ 
✔ 
Baseline= day of enrollment in the program 
Surveys completed ±2 weeks from targeted timeframe 
 
Registry Duration 
Registry enrollment will be ongoing. Participants will remain active in the registry until 
they voluntarily withdraw or expire. Any data that has been provided up until that point 
will continue to be included in the registry.  
 
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Data Management and Quality Plan  
Data De-identification 
Participants will be assigned a unique identifier instead of using their names, however 
other unique identifiers may still be included in the dataset (e.g., zip code and date of 
birth). The unique identifier will automatically be assigned by Salesforce based on the 
order of enrollment in the research registry. For instance, the first person to enroll in the 
research registry would be assigned 0001, the second would be assigned 0002, and so on. 
A spreadsheet will automatically be created in Salesforce when YASU members enroll in 
the research registry which will link the unique identifier to the participants. This 
spreadsheet will be stored in Salesforce separately from the registry dataset. The PI and 
YASU staff members may be granted access to this information as well as future research 
collaborators. We plan to keep this linking information available indefinitely. The link 
between the subject's identity and the assigned registry number may be broken if it 
becomes necessary to clarify survey responses or if survey responses require reaching out 
to the individual to provide resources (e.g., reporting on the PHQ-9 plans to harm or kill 
themselves or others). 
 
     
Data Confidentiality, Storage, and Retention 
Registry documentation and data will be stored electronically within Salesforce. 
Salesforce contributes to keeping ePHI secure in the Salesforce Covered Services by 
implementing security safeguards that apply to all customers by default such as: 
• Continually monitoring the services for security violations 
• Encrypting all data in transit 
• Storing user passwords in the SHA-256 one-way hash format 
• Enabling audit logging that allows system administrators to track certain change activity 
in the Salesforce Covered Services 
• Providing customer administrators with configurable tools to maintain strict password 
security policies which govern access 
• Providing customer administrators with configurable tools to define user profiles and 
permission sets governing data visibility 
• Providing customer administrators with configurable tools to define a company-wide 
sharing model, a role hierarchy, and security rules governing data access 
• Providing customer administrators with configurable tools for field level history 
monitoring and retention. 
 
 
Data Quality  
Source data verification is not necessary for this research registry because the electronic 
surveys are the source data. Prior to data analysis, data will be checked for anomalies or 
outliers which might suggest invalid data entry by participants.  
 
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Data Sharing 
​
Original records including identifiable data will be available to members of the research 
team and YASU organization for an indefinite period of time. Data may be shared with other 
researchers/groups with objectives inside or outside the primary aims of this study. In order to be 
granted access to our dataset, the outside researcher would need to secure IRB approval from an 
IRB for their proposed study and then would sign a YASU-provided confidentiality agreement. 
Datasets shared with researchers outside of YASU will not include identifiers. This new data 
may be made available to the general public via the Internet and an open database. This 
information will not have participants name or other personally identifiable information included 
(i.e. it will be de-identified).  
 
​
Future research collaborators outside of YASU may use the registry to contact 
participants for other studies and may have access to the linked Salesforce spreadsheet to screen 
for candidates. Outside researchers who wish to use contacts from the YASU research registry in 
recruitment for their study will be required to secure IRB approval for their proposed study and 
to complete the YASU-provided confidentiality agreement prior to any possible participant 
contact information being shared. Once IRB-approval has been received and the agreement is 
completed, the PI (and/or YASU executive director) may grant the requestor access to the 
requested information. 
 
Registry Data Points 
 
All data will be collected via electronic survey as described earlier. 
 
Initial baseline demographics will be collected at the time of registry enrollment and will include 
self-reported date of birth, race, gender, and address.  
 
Disease and treatment information will be collected via self-report at the time of consent to the 
research registry. Self-reported information that will be collected include age at diagnosis, type 
of cancer, stage, and treatment received. 
 
Patient Health Questionnaire 9 (PHQ-9) (Pfizer, 2010): The PHQ-9 is a 9-item self-reported 
instrument designed to assess depressive symptoms. For each of the questions, individuals 
choose one of the following responses regarding how they have been feeling in the past two 
weeks: Not at all (0), Several days (1), More than half the days (2), or nearly every day (3). The 
responses can be summed together to yield a total score from 0-27, with higher scores indicating 
more depressive symptoms. The PHQ-9 will be completed electronically via survey at baseline 
and annually. 
 
Generalized Anxiety Disorder (GAD-7) (Pfizer, 2010): The GAD-7 is a self-administered 7-item 
instrument to measure anxiety symptom severity. Like the PHQ-9, individuals think about how 
they have been feeling in the past two weeks and choose from the following answers: Not at all 
 
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(0), Several days (1), More than half the days (2), or nearly every day (3). Total scores range 
from 0-21, with higher scores indicating greater anxiety symptom severity. 
 
Adolescent and Young Adult Pyscho-Oncology Screening Tool (AYA-POST) (Patterson et al., 
2022): The AYA-POST provides a psychosocial screening and assessment for people diagnosed 
with cancer. The tool comprises a distress thermometer and age-specific needs assessment. The 
distress thermometer quantifies the amount of self-reported distress an individual has 
experienced over the past week ranging from 0 (no distress) to 10 (high distress). The needs 
assessment identifies areas of distress or concern in the following categories: practical, family, 
emotional, social, physical, information, and other (which allows for free response). 
 
COmprehensive Score for financial Toxicity-Functional Assessment of Chronic  
Illness Therapy (COST-FACIT) (Version 2) (FACITgroup, 2017): The COST-FACIT is a 12-item 
patient reported measure of financial distress for cancer patients. The measure provides a 
summary score for financial toxicity. Scores range from 0-44 with higher scores indicating better 
financial wellbeing. 
 
MOS Social Support Survey Instrument (Sherbourne & Stewart, 1992): The Social Support 
Survey is a self-administered, multidimensional social support survey that was specifically 
developed for patients with chronic health conditions. This 19-item measure consists of four 
separate social support subscales (emotional/informational support; tangible support; affectionate 
support; positive social interaction) and an overall functional social support index. Higher scores 
in the subscale and the overall support index indicate more support. 
 
 
 
Statistical Analysis Plan 
 
Aim 1 is to describe  patient-reported symptoms (depression, anxiety, distress), perceived 
social support, financial toxicity and needs in survivors of young adult cancer at baseline 
and over time. Baseline data will be summarized using descriptive statistics appropriate 
to the variable’s level of measurement. Repeated measures analysis of variance will be 
used to measure changes over time. 
 
Aim 2 is to determine effectiveness of YASU programming by examining its possible 
mediation on the measures of Aim 1. This will be assessed via mediation analysis suited 
to longitudinal data, such as a natural effect models (Mittinty & Vansteelandt, 2020).  
 
Once data are gathered we will determine whether to exclude missing data pair-wise or whether 
we plan to impute missing values, depending on the variable and the amount of missing data 
within and between cases.  
 
 
 
 
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Potential Risks and Benefits  
Potential Benefits 
There are no direct benefits to subjects for participating in this research registry.  
However, information regarding needs and wellbeing of young adult cancer survivors 
may result from this registry. 
 
Potential Risks​
 
This research represents a registry documenting the needs and outcomes of young adult 
cancer survivors.  The most likely risk posed to participants would be a breach of 
confidentiality if someone other than the research team obtained access to the data.   
 
We do not anticipate that completing registry surveys will increase the risk of depression 
or suicide, however these things may be reported on the depressive symptom measure. 
Resources for those that report suicidality will be provided including a suicide hotline 
and links to mental health resources. 
 
Mitigation of Risks  
 
Security measures in place to prevent breach of confidentiality from happening (e.g. 
using Salesforce, an application that upholds HIPAA privacy and security measures; 
employing features such as limiting access to identifiable data to only users that are 
associated with the registry). 
 
Participants’ responses to the depression inventory scale (PHQ-9) will be monitored.  
Resources for those that report suicidality will be provided including a suicide hotline 
and links to mental health resources. 
 
 
Provisions to Protect the Privacy Interest of Registry Participants 
All precautions will be taken to make sure that only authorized individuals will be 
accessing subject research records.  The collection of sensitive information about subjects 
is limited to the amount necessary to achieve the aims of the research registry, so that no 
unneeded sensitive information is being collected.  
 
Early Withdrawal of Subjects  
Investigator Withdrawal of Subjects 
Research registry participants will continue to be surveyed annually. If a participant does 
not complete surveys within the 4-week “grace period” (±2 weeks from targeted 
timeframe) the survivor will not be withdrawn from the registry, but these surveys will be 
considered as missing data in the data set. 
 
Subject Request for Withdrawal from Registry 
 
 
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Patients wishing to withdraw their data from the research registry will be directed to 
contact the principal investigator.  From the point of withdrawal, no further data will be 
collected from the patient or their medical records.  However, any data collected up to the 
point of withdrawal will be maintained for integrity of the research registry. Patients will 
be made aware of their rights in the consent. 
 
Data Collection and Follow-up for Withdrawn Subjects 
Patients who withdraw from the registry will have their data maintained in the research 
database up to the point of withdrawal.  This data will be included in subsequent analysis.  
 
Adverse Event Reporting  
Adverse Events 
 
N/A; This is an observational registry that does not include a planned intervention or 
exposure. 
 
 
Ethical Considerations 
N/A 
 
Sharing of Results with Subjects 
Individual participant results will not be shared with subjects or others. General 
results from aggregate data may be shared with participants. 
 
 
Funding Source 
Staunton Farm Foundation (07/01/23-06/30/24) 
Elsie H. Hillman Foundation (07/01/23-06/30/25) 
 
Subject Stipends or Payments 
Participants will be given a $15 Amazon gift card for completion of the initial set of surveys and 
a $10 Amazon gift card for subsequent survey sets (e.g., 6 month, 12 month, and 24 month 
follow-ups). 
 
 
 
 
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References 
 
Close, A. G., Dreyzin, A., Miller, K. D., Seynnaeve, B. K., & Rapkin, L. B. (2019). 
Adolescent and young adult oncology—past, present, and future. CA: A Cancer Journal 
for Clinicians, 69(6), 485-496. 10.3322/caac.21585 
FACITgroup. (2017). COST: A FACIT Measure of Financial Toxicity. FACIT.org. 
Retrieved December 19, 2022, from https://www.facit.org/measures/FACIT-COST 
Mittinty, M. N., & Vansteelandt, S. (2020). Longitudinal Mediation Analysis Using 
Natural Effect Models. American Journal of Epidemiology, 189(11), 1427-1435. 
10.1093/aje/kwaa092 
National Cancer Institute. (2020, September 24). Adolescents and Young Adults (AYAs) 
with Cancer. National Cancer Institute. Retrieved December 26, 2022, from 
https://www.cancer.gov/types/aya 
National Cancer Institute & Livestrong Young Adult Alliance. (2006, August). Closing 
the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancer. 
Patterson, P., McDonald, F. J., Allison, K. R., Bibby, H., Osborn, M., Matthews, K., 
Sansom-Daly, U. M., Thompson, K., Plaster, M., & Anazodo, A. (2022, May 6). The 
Clinical Utility of the Adolescent and Young Adult Psycho-Oncology Screening Tool 
(AYA-POST): Perspectives of AYA Cancer Patients and Healthcare Professionals. 
Frontiers in Psychology, 13. 10.3389/fpsyg.2022.872830 
Pfizer. (2010). PHQ Screeners. PHQ Screeners. Retrieved December 19, 2022, from 
https://www.phqscreeners.com/select-screener 
 
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Scott, A. R., Stoltzfus, K. C., Trifiletti, D. M., Lehrer, E. J., Rao, P., Bleyer, A., & 
Zaorsky, N. G. (2020). Trends in Cancer Incidence in US Adolescents and Young Adults, 
1973-2015. JAMA Network Open, 3(12), e2027738. 
10.1001/jamanetworkopen.2020.27738 
Sherbourne, C. D., & Stewart, A. (1992). Social Support Survey | RAND. RAND 
Corporation. Retrieved December 19, 2022, from 
https://www.rand.org/health-care/surveys_tools/mos/social-support.html 
Young Adult Survivors United. (n.d.). Retrieved December 26, 2022, from 
https://www.yasurvivors.org/ 
 
 
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