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

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

ABSTRACT: Young cancer survivors are often unprepared to face the complexities of adjusting to post-treatment life. They may be pleased that treatment is ending but worried about losing the support, security, and scrutiny provided by their healthcare team. Uncertainty about the prognosis for long-term, cancer-free survival often threatens their sense of control, emotional well-being, functional adjustment, and comfort with future planning. Many feel isolated, mistrust their bodies, and must adjust to an altered self-image as well as changes in relationships and sexual functioning. It can be daunting to deal with physical late effects, challenges to daily living, and employment and insurance issues. Using direct quotations from young cancer survivors, this article shares their special perspective and provides guidance as to their informational, practical, and psychosocial needs.

For young adult survivors, coming to terms with a life-threatening illness is a unique dilemma. They face the developmental tasks of youth with a challenged world view and a compromised physiology; completion of treatment does not mean the end of cancer. They may have difficulty returning to school, work, or other activities and are often forced into greater dependency on their family of origin, during a period when separation is a major life-cycle task. The transition from life as a patient undergoing treatment for cancer to a more independent role in close relationships and the world at large can be particularly challenging. Social relationships may not withstand the stigma of cancer, and the potential for recurrence of cancer can be anxiety-provoking even with a good prognosis.

Young adults (15–39 years of age) are eight times more likely than children under the age of 15 years to be diagnosed with cancer. Each year in the US, an estimated 70,000 young adults are diagnosed with cancer, and about 1 million young adult survivors are already grappling with issues related to the aftermath of the disease and its treatment.[1] Unfortunately, these survivors often lack access to networking and professionally led services geared towards the post-treatment period. This article will discuss issues relevant to young adult survivors. Personal statements quoted here come from young adults who participated in support services at an academic cancer center. All identifying information has been changed to maintain confidentiality.

IMPACT OF SURVIVORSHIP
Survivors often describe themselves as “rubber bands,” stretched increasingly taut through the treatment period and sometimes beyond. After treatment ends, the band may “snap” and the emotional impact of the cancer experience can catch up with them. This is the point at which many survivors begin to process the totality of their cancer experience; the physiological, emotional, and practical impact.

PHYSIOLOGICAL CHANGES
Most cancer survivors experience physical changes and challenges that are direct results of cancer and treatment. Adapting to short and long-term consequences of treatment often takes longer than anticipated. Common concerns include fatigue, physical losses, scarring, cognitive changes, sexuality, fertility, and sudden-onset menopause.[2–4] All of these issues have a significant impact on young adults and are best summarized in the phrase “loss of healthy self.”

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