Nursing Considerations for Adolescent and Young Adult Cancer Survivorship Care
Adolescent and young adults (AYAs)—those diagnosed between the ages of 15 and 39—comprise about 5% of all annual cancer diagnoses. The population has unique challenges that must be considered as part of patient-centered survivorship care planning.
Just like for adults with varying diagnoses, individual AYA survivorship care plans require a tailored approach and long-term care based on each patient’s disease type and treatment. However, as a population, AYA survivors have no standards for survivorship care. Many of their needs differ from those of adults, particularly for long-term health and psychosocial factors.
AYA survivorship considerations fall under three key categories:
- Long-term health
- Social relationships
Long-Term Health Survivorship Considerations
Although specific late and chronic effects vary depending on each patient’s disease and treatment, common issues include cardiovascular disease, neurologic deficits, dyslipidemias, endocrinopathies and gonadal dysfunction, and secondary malignancies. Secondary malignancies are a particular concern for AYA survivors who received thoracic radiation, anthracyclines, or alkylating agents, so National Comprehensive Cancer Network guidelines recommend considering specific radiologic testing and additional cancer screening based on type and dose of treatments. AYA survivors may also be at higher risk for chronic medical conditions.
Behavioral/Emotional Survivorship Considerations
AYA survivors experience significantly higher incidence of anxiety, depression, and post-traumatic stress disorder than older cancer survivors. They have concerns about relationships, costs of care, returning to work or school, disease recurrence, and fertility, which may result in fear and anxiety after treatment. Fear of disease recurrence can be paralyzing, and AYA survivors report wanting support in managing these fears and concerns. Oncology nurses should educate AYA survivors about signs and symptoms of disease recurrence, thoroughly assess them for coping strategies and access to an effective support system, and refer them to services such as fertility specialists, social workers, and cognitive-behavioral specialists as appropriate.
Social Relationship Survivorship Considerations
Young AYA cancer survivors are heavily reliant on parental figures, even into adulthood. They may be apprehensive to engage in meaningful social relationships and cite difficulty with dating, intimacy, and feeling different from their peers as negatively affecting their relationships. AYA survivors also say they feel left behind in terms of educational and professional progress and that they need support in building and maintaining social relationships. Oncology nurses can listen for patients’ concerns during treatment and refer them to appropriate support, such as survivorship groups or mental health professionals, to develop healthy relationships after treatment.
Integrate AYA Considerations Into Care
Studies have shown that clinicians lack knowledge of AYA survivors’ patient-centered needs and treatment centers lack specialized resources to effectively care for them. However, recognizing several principles can help oncology nurses profoundly improve AYA survivorship care:
- AYA survivors have a high likelihood of carrying pathogenic variants that may have implications for cancer surveillance and disease recurrence.
- Compared to older cancer survivors, they may exhibit different presenting signs and symptoms of recurrence as well as different long-term toxicity profiles.
- A cancer diagnosis during the AYA years may significantly exacerbate developmental challenges and threaten milestones long into survivorship.
AYA cancer survivors require age- and developmentally appropriate referrals and resources to help them adjust post-treatment. Oncology nurses must address their unique challenges so they can thrive throughout their adulthood ahead.