Understanding the Needs of Young Adult Cancer Survivors: A Clinical Perspective

This pressure, combined with societal expectations of the cancer survivor—the myth of the epiphany—can be a tremendous burden for young survivors: “Shouldn't I always be thankful, shouldn't it be that I never get upset by the small things and always focus on how fragile life is? I feel that I have betrayed myself because I am not acknowledging how lucky I am all the time.” While some will make major life changes, many will not and will find this pressure to be an impediment to the process of acclimation to life beyond cancer.[18]

PRACTICAL CONCERNS
Just as the cancer experience has an impact on physiological and emotional aspects of development, practical matters are also affected: roles, relationships, goal-setting, education, career, finances, insurance.[19–21] Cancer and its treatments interrupt normal developmental pathways. In addition to the emotional aspects of intimate disclosure, for example, young adults may struggle with the practical aspects of public disclosure. They may be inclined to disclose that they are cancer survivors because of the prominence of the experience in their lives, but they may be justifiably concerned about the implications of telling educators, employers, and new acquaintances about their illness: “At first, you tell everyone. Then you realize your vulnerability. Then you share more wisely.”

School, work, financial development, plans, and relationships can be cut off, put on hold, or challenged in any number of ways during treatment. All of this must be addressed during the post-treatment period: “I have lost my self-discipline, my sense of achievement. Every hurdle, whether it is prejudice in hiring a cancer survivor or anything else, diminishes my hope of pursuing my dreams.” These concerns are the external defining elements of daily life that enable young adults to develop a sense of identity and purpose and to function in the world. Often, these are the issues that survivors first identify as distressing.

Ultimately, social issues at every level become salient for young adult survivors. Access to information relevant to cancer survivors' legal rights, resume writing, job hunting, disclosure, and the opportunity to connect with others who have faced the social hurdles that arise in the wake of cancer, can be an indispensable asset in the process of recovery.[22] “We're all similar in a big way— everyone thinks we're out of the cancer world and dealing REALLY well. But, in our own minds we're not, we're still very much there. It's comforting to know that there are people who understand what it feels like to be you.”

CONCLUSION
The end of treatment can signal a complex period of recovery. For young adults, the most salient concerns that arise are as closely related to their developmental stage as to the cancer experience itself. Physical, emotional, and practical recovery can be assisted and supported through appropriate clinical services and interventions. Psychoeducational support services such as those provided by organizations like Memorial Sloan-Kettering's Post-Treatment Resource Program, CancerCare, the Lance Armstrong Foundation, I'm Too Young For This, or Planet Cancer can be critical factors in healing.

These organizations can be significant resources as young adults grapple with the process of integrating the cancer experience and seek to reduce the negative and intractable power of cancer. A sense of normalcy can be regained and the motivation to move forward can be more firmly established. The illness and its aftermath can come to be understood not as a defining aspect of the self but as just one of many aspects of a survivor's identity: “It's all part of feeling a new sense of being you. It's strange how this can simultaneously make you feel more confident and more insecure.”

Given the current national interest in cancer survivorship,[23] and the issues unique to this population, the field is ripe for an increased focus on young adult survivorship. The intersection of post-treatment recovery and young adult development presents highly promising entities for clinicians and researchers. In spite of the losses, the sadness, the anger, and the confusion, young adult survivorship is potentially a period of significant growth, possibility, and hope.